Background-Although fatty foods are commonly considered detrimental in patients with reflux disease, no objective data exist that substantiate this belief. Aims-To investigate the eVect of fat on gastro-oesophageal reflux and lower oesophageal sphincter (LOS) motor activity. Subjects-Thirteen healthy subjects and 14 patients with reflux disease. Methods-Oesophageal pH, LOS, and oesophageal pressures were recorded for 180 minutes after a high fat (52% fat) and a balanced (24% fat) meal (both 3.18 MJ) on two diVerent occasions. Eight controls and seven patients were studied in the recumbent position and the others in the sitting position. Results-The percentage of time at pH less than 4 and the rate of reflux episodes were higher (p<0.01) in the patients than in the healthy subjects (mean 14.1% versus 1.7% and 4.4/h versus 0.8/h respectively), as was the percentage of transient LOS relaxations associated with reflux (62% versus 32%, p<0.01). The high fat meal did not increase the rate of reflux episodes nor exposure to oesophageal acid in either group regardless of body posture.The rate of transient LOS relaxations, their association with reflux, and basal LOS pressure were also unaVected. Conclusions-Increasing fat intake does not aVect gastro-oesophageal reflux or oesophagogastric competence for at least three hours after a meal. (Gut 1998;42:330-333)

In order to evaluate the function of inhibitory neural pathways in achalasia, we compared the response of the oesophageal body and lower oesophageal sphincter (LOS) to single swallows (SS) and multiple rapid swallowing (MRS) in 20 consecutive patients with untreated idiopathic achalasia (10 men, aged 23-81 years) and in 20 control patients without dysphagia (nine men, aged 31-73 years), using sleeve manometry; 277 SS and 85 MRS were analysed. In the control group, MRS inhibited motor activity in the oesophageal body and induced a slightly lower (P < 0.05) nadir LOS pressure compared with SS. In the achalasia patients, MRS induced a variable response: eight patients had simultaneous motor activity during all MRS although onset was delayed compared with SS [median (interquartile range), 3.5 s (1.7-6.1) vs 1.4 s (0.8-3.9); P < 0.05], whereas eight patients showed motor inhibition which occurred during all MRS in four of them, and the remaining four had no motor activity both after SS and during MRS. Overall MRS did not decrease nadir LOS pressure compared with SS [12 mmHg (5-20) vs 16 mmHg (7-22); P > 0.1]; however, it induced complete LOS relaxation in three of the patients. MRS gives further evidence of functional heterogeneity among achalasia patients.

Our data suggest that advice on dietary habits in patients with GOR disease should be concentrated on decreasing the caloric load of meals rather than their fat content.

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...

Loperamide did not decrease GOR, thus suggesting that an opioid agonist may not be useful in the treatment of GOR disease.

One or two pneumatic dilatations induce stable clinical remission and a decrease in LOS pressure that remains unchanged over time. Our data further support the use of dilatations as first-line treatment of achalasia.

The proposed mathematical analysis of frequent ultrasonographic measurements of the GB volumes enables one to estimate noninvasively the flux of bile through the gallbladder in humans.

No abstract