Increased frequency of transient lower esophageal sphincter relaxation induced by gastric distention in reflux patients with hiatal hernia

Kahrilas, Peter J.; Shi, Guey‐Yueh; Manka, Michael; Joehl, Raymond J.

doi:10.1016/s0016-5085(00)70138-7

Cited by 297 publications

(196 citation statements)

References 24 publications

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“…These findings confirm that peristaltic dysfunction contributes to increased oesophageal exposure to refluxed acid material, 31 particularly in the supine position when it is associated with impaired oesophageal clearance. 34 Moreover, our results confirm that the presence of hiatal hernia contributes much more than the basal lower oesophageal sphincter tone to the presence and severity of endoscopically detectable mucosal lesions in GERD, [35][36][37] and this is in keeping with its relevance in the management of complicated and atypical GERD. 26 The severity of heartburn was similar between the three groups of patients in our series, confirming that NERD should not be considered as a mild form of GERD, 3 and that the severity of reflux symptoms is similar when patients with erosive reflux oesophagitis and with complicated reflux disease are compared.…”

Section: Discussionsupporting

confidence: 81%

Different patterns of oesophageal acid exposure distinguish complicated reflux disease from either erosive reflux oesophagitis or non‐erosive reflux disease

Frazzoni

Micheli

Savarino

2003

Aliment Pharmacol Ther

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SummaryBackground : The reason why less than one‐half of patients with gastro‐oesophageal reflux disease develop complicated reflux disease (ulcerative oesophagitis, oesophageal strictures and Barrett's oesophagus) and erosive reflux oesophagitis is not fully understood. Supine nocturnal oesophageal acid reflux is considered to be critically involved in this phenomenon, but reliable data are lacking.Aim : To clarify whether high levels of supine nocturnal oesophageal acid exposure are associated with complicated reflux disease.Methods : Ambulatory 24‐h oesophageal pH monitoring was performed in 220 patients with gastro‐oesophageal reflux disease (56 with complicated reflux disease, 76 with erosive reflux oesophagitis and 88 with non‐erosive reflux disease). The total, supine nocturnal and upright diurnal percentage acid reflux times were calculated.Results : The total percentage acid reflux time was significantly greater in complicated reflux disease than in either erosive reflux oesophagitis (P = 0.024) or non‐erosive reflux disease (P = 0.000). These differences were entirely due to a greater supine nocturnal percentage acid reflux time (P = 0.038 and P = 0.000, respectively), whereas no difference was observed in the upright diurnal percentage acid reflux time.Conclusions : Complicated reflux disease is characterized by high levels of supine nocturnal percentage acid reflux time. Prospective studies would be appropriate to clarify whether the normalization of this parameter is relevant to the effective management of this subset of patients with gastro‐oesophageal reflux disease.

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Section: Discussionsupporting

confidence: 81%

Different patterns of oesophageal acid exposure distinguish complicated reflux disease from either erosive reflux oesophagitis or non‐erosive reflux disease

Frazzoni

Micheli

Savarino

2003

Aliment Pharmacol Ther

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“…[4][5][6][7][8] It has recently been reported that esophageal motor activities and compliance of the esophagogastric junction (EGJ) is important for prevention of gastroesophageal reflux, with the latter considered to cause greater volume reflux of gastric contents into the esophagus. [9][10][11] Fundoplication surgery for repairing the EGJ has been consistently shown to prevent pathological gastroesophageal reflux by restoration of normal EGJ compliance.…”

Section: Introductionmentioning

confidence: 99%

“…Limited EGJ distensibility reduces large volume fluid reflux from the stomach and that in GERD patients has been reported to be augmented to a greater degree than that seen in healthy controls. [9][10][11] Prokinetic agents are expected to improve those antireflux functions and considered to be effective for treatment of GERD. 28 We previously reported that high-dose mosapride (40 mg) not only augmented esophageal peristaltic contractions and mean resting LES pressure, but also reduced EGJ compliance, whereas a standard dosage did not consistently change esophageal motor activity.…”

mentioning

confidence: 99%

Effects of Metoclopramide on Esophageal Motor Activity and Esophagogastric Junction Compliance in Healthy Volunteers

Mikami

Ishimura

Fukazawa³

et al. 2015

J Neurogastroenterol Motil

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Background/AimsProkinetic drugs such as metoclopramide are frequently used as second-line therapy for patients with gastroesophageal reflux disease. However, their beneficial effects remain unclear. Esophageal motor activities and compliance of the esophagogastric junction (EGJ) are important for prevention of gastroesophageal reflux. Although metoclopramide has been reported to increase lower esophageal sphincter (LES) pressure, its effects on EGJ compliance have not been evaluated. In the present study, we investigated the effects of metoclopramide on esophageal motor activities and EGJ compliance. MethodsNine healthy male volunteers without abdominal symptoms were enrolled. Peristaltic esophageal contractions and LES pressure were examined using high-resolution esophageal manometry, while EGJ compliance was evaluated with an endoluminal functional lumenimaging probe. After obtaining baseline values for esophageal motor activities and EGJ compliance, metoclopramide (10 mg) was intravenously administered, then all measurements were repeated at 15 minutes after administration in each subject. ResultsFollowing administration of metoclopramide, mean resting LES pressure was significantly increased as compared with the baseline (13.7 ± 9.2 vs 26.7 ± 8.8 mmHg, P < 0.05). In addition, metoclopramide significantly augmented peristaltic contractions, especially in the distal esophageal segment (P < 0.05). On the other hand, distensibility index did not change after administration (4.5 ± 0.5 vs 4.1 ± 0.5 mm 2 /mmHg), suggesting no significant effect of metoclopramide on EGJ compliance. ConclusionsMetoclopramide augmented esophageal contractions without changing EGJ compliance in healthy adults.(J Neurogastroenterol Motil 2016;22:112-117)

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“…The main stimulus for TRLES is gastric distension especially in the gastric fundus. 5 Pandofino et al 6 reported esophageal manometric findings suggesting that the pressure morphology within and across the esophagogastric junction were altered in obesity, which could augment the flow of gastric juices into the esophageal lumen. This anatomical disruption of the esophagogastric junction results in further hiatal hernia formation.…”

mentioning

confidence: 99%

Association Between Visceral Fat and Inflammatory Cytokines in Reflux Esophagitis

Kim

2015

J Neurogastroenterol Motil

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Increased frequency of transient lower esophageal sphincter relaxation induced by gastric distention in reflux patients with hiatal hernia

Cited by 297 publications

References 24 publications

Different patterns of oesophageal acid exposure distinguish complicated reflux disease from either erosive reflux oesophagitis or non‐erosive reflux disease

Different patterns of oesophageal acid exposure distinguish complicated reflux disease from either erosive reflux oesophagitis or non‐erosive reflux disease

Effects of Metoclopramide on Esophageal Motor Activity and Esophagogastric Junction Compliance in Healthy Volunteers

Association Between Visceral Fat and Inflammatory Cytokines in Reflux Esophagitis

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