Terminating motor events for TLESR are influenced by the presence and distribution of refluxate

Abstract

Transient lower esophageal sphincter relaxation (TLESR) is frequently associated with reflux events and terminates with a primary or secondary peristaltic wave. However, it is unclear whether the presence and properties of the refluxate affect TLESR-termination events. The aims of this study were to determine the pattern of terminating esophageal motor activity after TLESR in healthy subjects and factors affecting the type of terminating motor event. Fifteen healthy subjects (7 men, age 18-56) were studied. High-resolution manometry and impedance/pH monitoring were performed simultaneously in supine position for 2 h after subjects took a 1,000-kcal meal (Awake Study). This procedure was repeated during the night under polysomnographic recording for 6-8 h after consuming a 1,000-kcal meal (Sleep Study). We categorized three types of TLESR-terminating motor events, primary peristalsis (PP), full secondary contraction (FSC), which propagated the entire esophagus, and partial secondary contractions (PSC), which started distal to the upper esophageal sphincter. Overall, 289 TLESR events were found. The percentages of TLESR events terminated by PP, FSC, and PSC were 22%, 14%, and 64%, respectively. TLESR events terminated by PP were less likely to be accompanied by reflux events. TLESR events terminated by FSC were significantly more likely to have evidence for proximal esophageal reflux and esophago-pharyngeal reflux. Findings were similar in awake and sleep states. We concluded that, in healthy recumbent subjects, the most common TLESR-termination event is a secondary contraction, rather than PP. Presence and distribution of the refluxate is a major influence on the type of terminating contraction.

Review article: the clinical relevance of transient lower oesophageal sphincter relaxations in gastro-oesophageal reflux disease

“…31 Transient lower oesophageal sphincter relaxations terminated either by primary peristalsis or partial secondary contraction were of equal duration but TLOSRs terminated by full secondary contraction were shown to have a significantly longer duration of LOS relaxation. 31 The duration of TLOSRs is not dependent on whether or not it is associated with reflux.…”

“…31 The first motor event is the swallow-induced primary peristalsis, characterised by UOS relaxation with pharyngeal contraction and oesophageal peristalsis progressing along the entire oesophagus. The second and third types of motor events are full and partial secondary contraction.…”

“…3,8,32 However, later studies concluded that the most common event that leads to termination of a TLOSR is secondary contraction. 2,28,31 The type of terminating event can be predicted by the occurrence and nature of gastro-oesophageal reflux as, in particular, partial secondary contraction was more likely during distal gastro-oesophageal reflux and full secondary contraction was more likely during proximal reflux. 31 This pattern is not dependent on the acidity of the refluxate.…”

“…2,28,31 The type of terminating event can be predicted by the occurrence and nature of gastro-oesophageal reflux as, in particular, partial secondary contraction was more likely during distal gastro-oesophageal reflux and full secondary contraction was more likely during proximal reflux. 31 This pattern is not dependent on the acidity of the refluxate. 31 Transient lower oesophageal sphincter relaxations terminated either by primary peristalsis or partial secondary contraction were of equal duration but TLOSRs terminated by full secondary contraction were shown to have a significantly longer duration of LOS relaxation.…”

Practical aspects of high resolution esophageal manometry

“…Characteristically, TLESRs with longer duration, lower nadir pressure, more diaphragmatic inhibition and ending with a secondary wave are those accompanied by reflux (48) (Fig. 2).…”