SUMMARY In order to investigate the relationship between oesophageal motor abnormalities and oesophagitis, we carried out four hour studies of oesophageal motility and 24 hour pH measurements in fasting and fed conditions in eight patients before, during (pH only), and after medical healing of erosive oesophagitis. Gastrooesophageal acid reflux decreased (ns) during the treatment, but tended to return to basal values at the end. Oesophageal body motility was unchanged after healing, while the lower oesophageal sphincter basal tone was significantly increased at the end of the study in the postcibal period. The results suggest that the impairment of the sphincter tone in reflux oesophagitis is secondary to the presence of the oesophageal lesions. Macroscopic healing is not paralleled by improved major pathogenic factors of the disease, however -that is, acid reflux and oesophageal body motility.It is well established that oesophageal motor abnormalities play a major role in the pathogenesis of reflux oesophagitis. '-Moreover, animal4" and studies in man"7 have shown that the impairment of the lower oesophageal sphincter (LOS) tone parallels the severity of the oesophageal lesions. It is, however, not yet clearly defined whether the motor abnormalities precede or follow the appearance of the mucosal lesions. In fact, only few studies," performed for short periods of time, have investigated the oesophageal function before and after healing of the oesophagitis.Our aim was, thus, to evaluate both oesophageal motility and acid gastrooesophageal reflux for prolonged periods, before and after regression of erosive oesophagitis. Methods SUBJECTS ANI) EXPERIMENTAL DESIGNEleven outpatients with endoscopic evidence of uncomplicated erosive oesophagitis
SUMMARY In order to assess the oesophageal motor events associated with the occurrence of gastro-oesophageal acid reflux and those during endogenous acid exposure, we studied six healthy subjects and nine patients with symptoms and lesions of reflux oesophagitis. In the case of each subject simultaneous pressure and pH measurements of the distal oesophagus were taken both in fasting conditions and after a standardised balanced meal. Reflux episodes occurred in the absence of a lower oesophageal sphincter relaxation (34.3%, 17-7%) or in the presence of a relaxation associated (34-2%, 30.8%) or unassociated (31.5%, 51.5%) with a peristaltic sequence, in the controls and patients respectively. No significant differences were found between the two groups. During endogenous acid perfusion the distal oesophagus showed mainly a peristaltic motor activity, but the mean hourly number of peristaltic sequences was significantly lower in the patients than in the controls (33-5±27-2 vs 81-5±3-2, p<0.01). Our results show that the mechanisms of reflux are similar in controls and in patients, while the peristaltic frequency is reduced in the latter. This motor failure may be responsible for the increased reflux duration observed in patients with oesophagitis.Gastro-oesophageal acid reflux can be assessed and quantified by means of reliable techniques.1 2 Nevertheless, there is no agreement regarding the mechanisms of reflux; this is particularly true with regard to the role of the lower oesophageal sphincter. Some authors35 consider a low basal tone of the lower oesophageal sphincter a major cause of reflux, whereas others6 7 suggest that reflux may be related to sphincteric relaxations, particularly when they occur in the absence of a peristaltic sequence.Moreover, manometric studies have shown a failure of the peristaltic function of the oesophageal body in patients with oesophagitis both in basal conditions8S-" and during exogenous acid exposure of the oesophageal mucosa. 1213 Little information is available regarding oesophageal motilitT during reflux induced endogenous acid exposure.The aim of our study was to evaluate, in normal subjects and in patients with oesophagitis: (a) the oesophageal motor events at the occurrence of Address for correspondence: Dr F Baldi, III Clinica Medica, Policlinico S. Orsola, via Massarenti n. 9, 40138 Bologna, Italy. Received for publication 15 June 1984 gastro-oesophageal acid reflux, and (b) the motor activity of the distal oesophagus during acid reflux. Methods SUBJECTSWe performed oesophageal motility and pH studies on six healthy volunteers (four men, age range 23-41 years) and nine patients (six men, age range 24-59 years) with heartburn and/or regurgitation of at least six months duration and endoscopically proved erosive oesophagitis, in the absence of peptic stricture.
In 17 patients with esophagitis (degree I = erythema, N = 10; degree II = erosions, N = 7) esophageal pH was measured at 5 and 10 cm above the esophagogastric junction to assess whether the extension of acid reflux and the severity of the mucosal lesions could influence the association between reflux and symptoms. A minority of the refluxes were related with symptoms (4.0% and 7.7% in degree I, 14.1% and 12.0% in degree II at 5 and 10 cm respectively), whereas 65.4% and 100% of the symptoms were related with reflux in degrees I and II, respectively, with 76.5% and 35.7% occurring during refluxes reaching the proximal recording site. A relationship of symptoms with reflux is shown, particularly in erosive disease. Some reflux characteristics (extension, duration, acidity) seem to influence symptom occurrence mainly in mild esophagitis; however, more than 85% of the acid reflux episodes are symptom-free, regardless of the severity of the mucosal injury.
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