Motor function of the proximal stomach and visceral perception in gastro-oesophageal reflux disease

Penagini, Roberto; Hebbard, Geoffrey; Horowitz, Michael; Bermingham, H.; Holloway, Richard H.

doi:10.1136/gut.42.2.251

Cited by 117 publications

(98 citation statements)

References 40 publications

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“…In terms of mechanisms underlying these relationships in elderly GERD patients, both the intra-abdominal pressure increased by spinal kyphotic deformity and esophageal hiatus hernia can be caused (10,12). The literature contains several reports of poor gastric emptying in GERD patients (6,19,20,25). In recent years electrogastrography (EGG), a method that records the myoelectrical signal from the gastric smooth muscle through electrodes positioned on the abdominal skin (2), has been utilized to evaluate gastric function in a non-invasive manner (4).…”

mentioning

confidence: 99%

Impact of lumbar kyphosis on gastric myoelectrical activity and heart rate variability in a model using flexion posture in healthy young adults

Tsuchie¹,

Fukata²,

Takahashi³

et al. 2011

Biomed. Res.

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Relationship between lumbar kyphotic deformity and gastroesophageal reflux disease has been indicated in recent years. But it remains unclear whether kyphotic deformity of the lumbar vertebrae affects gastric motility. Healthy young adults (n = 20) were analyzed by recording the electrogastrography (EGG) and heart rate variability (HRV) before and after meal with flexion and neutral postures. Dominant power (DP) and dominant frequency (DF) of EGG and low frequency (LF) and high frequency (HF) of HRV were analyzed in blocks of 10 minutes' duration. In neutral posture, DPs of all postprandial durations were significantly higher than those during fasting in two channels (P < 0.05, P < 0.01). However, in flexion posture, only DP at postprandial 20 (10-20 minutes after eating) in a channel was significantly higher than that during fasting (P < 0.05). DF in neutral posture was significantly higher than that in flexion posture at postprandial 20 in a channel (P < 0.05). The standard deviation of DF at postprandial 10 in flexion posture was significantly higher than that during fasting in a channel (P < 0.05). LF/HF in neural posture was significantly higher than that in flexion posture at postprandial 10 (P < 0.05). These findings suggest that inhibition of stomach myoelectrical activity was induced in the flexion posture in this lumbar kyphotic model, and autonomic activity as assessed by HRV did not accord with that expected from EGG.

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mentioning

confidence: 99%

Impact of lumbar kyphosis on gastric myoelectrical activity and heart rate variability in a model using flexion posture in healthy young adults

Tsuchie¹,

Fukata²,

Takahashi³

et al. 2011

Biomed. Res.

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“…Some data suggest that the physiological postprandial increase in transient LES relaxations is more marked and prolonged in patients with GER disease than in controls (11). Although this could be partly due to a delayed recovery of proximal gastric tone after a meal (20), it is possible to hypothesize impaired adaptation of the rate of transient LES relaxation to prolonged gastric distension, which may be secondary to the autonomic nerve dysfunction already described in patients with GER disease (4,5).…”

Section: Discussionmentioning

confidence: 89%

Effect of prolonged gastric distension on motor function of LES and of proximal stomach

Allocca

Mangano

Penagini

2002

American Journal of Physiology-Gastrointestinal and Liver Physi

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Allocca, M., M. Mangano, and R. Penagini. Effect of prolonged gastric distension on motor function of LES and of proximal stomach. Am J Physiol Gastrointest Liver Physiol 283: G677-G680, 2002. First published April 10, 2002 10.1152/ajpgi.00526.2001.-Gastric distension is a potent stimulus of transient lower esophageal sphincter (LES) relaxation. To investigate the time effect of prolonged gastric distension on the rate of transient LES relaxations, LES pressure, and the motor and sensory functions of the proximal stomach, we performed a continuous isobaric distension of the proximal stomach at the 75% threshold pressure for discomfort for 2 h in seven healthy subjects. A multilumen assembly incorporating a sleeve and an electronic barostat was used. The rate of transient LES relaxations (n/30 min) was constant during the first hour [4.1 Ϯ 1.2 (0-30 min) and 5.4 Ϯ 1.1 (30-60 min)] but markedly decreased (P Ͻ 0.05) in the second hour [2.1 Ϯ 0.5 (60-90 min) and 2.3 Ϯ 0.9 (90-120 min)], whereas LES pressure, baseline volume and volume waves within the gastric bag, hunger, and fullness did not change throughout the experiment. It is concluded that the rate of transient LES relaxations decreases with time during prolonged gastric distension, thus suggesting that this type of stimulus should not be used in sequential experimental conditions. gastric tone; lower esophageal sphincter pressure; barostat TRANSIENT LOWER ESOPHAGEAL SPHINCTER (LES) relaxation is the mechanism that allows venting of gas during belching, and it is now established to represent an important motor event underlying gastroesophageal reflux (GER) in patients with GER disease (6, 16). There is ongoing interest in developing drugs that can decrease GER by interfering with transient LES relaxations (3,9,14,15,19). In addition to exploring possible new approaches to the treatment of GER disease, this research is valuable in gathering information concerning the neural pathways involved in the control of transient LES relaxations. To perform studies of an acceptable duration, the rate of transient LES relaxations needs to be stimulated. This has so far been done by means of various experimental models that have used proximal gastric distension as a stimulus (7, 10). The most physiological model is the ingestion of a meal, but because the rate of transient LES relaxations is not constant over the postprandial period (11, 18), presumably because of gastric emptying, it is difficult to assess more than one experimental condition per day. Furthermore, this model, as well as others using gas (24), liquid infusion in the fundus (12, 19), or balloon inflation without the use of a barostat (10), does not allow simultaneous monitoring of the effects of the study drug on the rate of transient LES relaxations and proximal gastric motor function. Understanding the relationship between these two variables is vital to increase our knowledge of the control of transient LES relaxations and for future drug development (23).Distension of the proximal stomach by means of a...

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“…Based on studies showing that patients with GERD may have regional gastric motor abnormalities (16)(17)(18)(19)(20) and that the IJ area of C.L.A. Barbieri et al…”

Section: Discussionmentioning

confidence: 99%

“…Also, delayed gastric emptying, which might cause distension of the stomach, has been reported in substantial proportions of patients with GERD (8)(9)(10)(11)(12), although others have failed to confirm this finding (13)(14)(15)(16). More recently, it has been shown that patients with GERD may have regional disturbances of gastric motility, such as increased (16)(17)(18)(19) or decreased (20) retention of chyme in the proximal stomach, which may occur independently of gastric emptying rates.…”

Section: Introductionmentioning

confidence: 99%

Residence of liquids in the infra-junctional portion of the proximal stomach in patients with gastroesophageal reflux disease

Barbieri

Troncon

Herculano

et al. 2005

Braz J Med Biol Res

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Patients with gastroesophageal reflux disease may have disturbances of gastric motility, which could play a role in the pathophysiology of the disease. Recent studies have suggested that the gastric region just below the gastroesophageal junction may have a distinct physiological behavior. We determined whether patients with gastroesophageal reflux disease have abnormal residence of food in the infra-junctional portion of the stomach after ingesting a liquid nutrient meal. Fasted adult patients with reflux disease (N = 11) and healthy volunteers (N = 10) ingested a liquid meal (320 ml; 437 kcal) labeled with 99m technetium-phytate and their total gastric emptying half-time and regional emptying from the stomach infra-junctional region were determined. In 8 patients, episodes of postprandial acidic reflux to the esophagus were measured for 2 h using pH monitoring. There were no differences between reflux patients and controls regarding total gastric emptying time (median: 68 min; range: 39-123 min vs 65 min and 60-99 min, respectively; P > 0.50). Food residence in the infrajunctional area was similar for patients and controls: 23% (range: 20-30) vs 27% (range: 19-30%; P = 0.28) and emptying from this area paralleled total gastric emptying (Rs = 0.79; P = 0.04). There was no correlation between residence of food in the infra-junctional area and episodes of gastroesophageal reflux (Rs = 0.06; P = 0.88). We conclude that it is unlikely that regional motor disturbances involving the infra-junctional region of the stomach play a relevant role in the pathogenesis of acidic gastroesophageal reflux. Correspondence

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Motor function of the proximal stomach and visceral perception in gastro-oesophageal reflux disease

Cited by 117 publications

References 40 publications

Impact of lumbar kyphosis on gastric myoelectrical activity and heart rate variability in a model using flexion posture in healthy young adults

Impact of lumbar kyphosis on gastric myoelectrical activity and heart rate variability in a model using flexion posture in healthy young adults

Effect of prolonged gastric distension on motor function of LES and of proximal stomach

Residence of liquids in the infra-junctional portion of the proximal stomach in patients with gastroesophageal reflux disease

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