Cardiac autonomic regulation differentiates reflux disease with and without erosive esophagitis

Chen, Chien‐Lin; Orr, William C.; Yang, Cheryl C.H.; Kuo, Terry B.J.

doi:10.1080/00365520600575688

Cited by 25 publications

(24 citation statements)

References 31 publications

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“…Autonomic function might be deranged in patients with reflux disease also; indeed, autonomic dysfunction has been reported in patients with reflux disease [61], but it has not been investigated in subset of patients with BE. Of course, the present study does not permit identification of the exact gastroduodenal motor events that result in an increased duodenogastroesophageal reflux in patients with BE; this would require a separate study of the measurement of gastric emptying.…”

Section: Discussionmentioning

confidence: 99%

Increased Prevalence of Gallstone Disease and Impaired Gallbladder Motility in Patients with Barrett’s Esophagus

et al. 2007

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The prevalence of gallstones in patients with Barrett's esophagus (BE) and their gallbladder motility relative to that of healthy volunteers and GERD patients without BE were investigated. Of the 707 patients reviewed, 203 (125 males and 78 females) had BE. The prevalence of gallstones was significantly higher in the patients with BE than in those without BE (34 vs. 20%, respectively). The gallbladder functions of 22 patients with GERD, 27 patients with BE and 21 healthy volunteers were assessed by ultrasonography before and after a test meal. The patients with BE had significantly higher fasting volume and residual volume, but lower ejection volume, ejection fraction and ejection rate values than those of the healthy controls. None of the ultrasonographic parameters of patients without BE were significantly different from those of the controls. Patients with BE have a more complex gastrointestinal motility disorder that involves the gallbladder, and this makes this subset of patients with GERD more prone to gallstone disease.

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Section: Discussionmentioning

confidence: 99%

Increased Prevalence of Gallstone Disease and Impaired Gallbladder Motility in Patients with Barrett’s Esophagus

et al. 2007

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“…It seems also unlikely that differences between the GORD and control groups regarding gender distribution could have influenced our results, since the increased proportion of women among patients would be associated with decreased antral contractility, as demonstrated in another scintigraphy study 20 . Another possibility is that increased amplitude of antral contractions might be caused by diminished inhibition of antral motor activity secondary to autonomic dysfunction, which has been suggested as occurring in GORD patients 34,35 . Disturbed relaxation of the proximal stomach in response to a meal, which has been demonstrated in GORD, 7–11 could also be involved in the origin of increased antral contractility, as distension of the gastric fundus can enhance or inhibit antral contractility through gastro‐gastric reflexes 36,37 .…”

Section: Discussionmentioning

confidence: 99%

Postprandial gastric antral contractions in patients with gastro‐oesophageal reflux disease: a scintigraphic study

Barbieri

Troncon

Herculano

et al. 2008

Neurogastroenterology Motil

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Disturbed gastric contractility has been found in manometric studies in patients with gastro-oesophageal reflux disease (GORD), but the pathophysiological role of this abnormality is unclear. We aimed at assessing postprandial gastric antral contractions and its relationships with gastric emptying and gastro-oesophageal reflux in GORD patients. Fasted GORD patients (n = 13) and healthy volunteers (n = 13) ingested a liquid meal labelled with 72 MBq of 99mTechnetium-phytate. Gastric images were acquired every 10 min for 2 h, for measuring gastric emptying half time. Dynamic antral scintigraphy (one frame per second), performed for 4 min at 30-min intervals, allowed estimation of both mean dominant frequency and amplitude of antral contractions. In GORD patients (n = 10), acidic reflux episodes occurring 2 h after the ingestion of the same test meal were determined by ambulatory 24-h oesophageal pH monitoring. Gastric emptying was similar in GORD patients and controls (median; range: 82 min; 58-126 vs 80 min; 44-122 min; P = 0.38). Frequency of antral contractions was also similar in both groups (3.1 cpm; 2.8-3.6 vs 3.2 cpm; 2.4-3.8 cpm; P = 0.15). In GORD patients, amplitude of antral contractions was significantly higher than in controls (32.7%; 17-44%vs 23.3%; 16-43%; P = 0.01), and correlated positively with gastric emptying time (R(s) = 0.58; P = 0.03) and inversely with the number of reflux episodes (R(s) = -0.68; P = 0.02). Increased amplitude of postprandial gastric antral contractions in GORD may comprise a compensatory mechanism against delayed gastric emptying and a defensive factor against acidic gastro-oesophageal reflux.

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“…Autonomic abnormalities have been reported in both ERD and NERD patients [54, 55]. A study by Shapiro et al [32] found no differences in baseline autonomic function between functional heartburn and NERD patients.…”

Section: Disease Assessment For Nerd Studiesmentioning

confidence: 99%

Diagnosis and Management of Non-Erosive Reflux Disease – The Vevey NERD Consensus Group

et al. 2009

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Background/Aims: Although considerable information exists regarding gastroesophageal reflux disease with erosions, much less is known of non-erosive reflux disease (NERD), the dominant form of reflux disease in the developed world. Methods: An expert international group using the modified Delphi technique examined the quality of evidence and established levels of agreement relating to different aspects of NERD. Discussion focused on clinical presentation, assessment of clinical outcome, pathobiological mechanisms, and clinical strategies for diagnosis and management. Results: Consensus was reached on 85 specific statements. NERD was defined as a condition with reflux symptoms in the absence of mucosal lesions or breaks detected by conventional endoscopy, and without prior effective acid-suppressive therapy. Evidence supporting this diagnosis included: responsiveness to acid suppression therapy, abnormal reflux monitoring or the identification of specific novel endoscopic and histological findings. Functional heartburn was considered a separate entity not related to acid reflux. Proton pump inhibitors are the definitive therapy for NERD, with efficacy best evaluated by validated quality-of-life instruments. Adjunctive antacids or H₂ receptor antagonists are ineffective, surgery seldom indicated. Conclusions: Little is known of the pathobiology of NERD. Further elucidation of the mechanisms of mucosal and visceral hypersensitivity is required to improve NERD management.

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Cardiac autonomic regulation differentiates reflux disease with and without erosive esophagitis

Abstract: Patients with ERD and NERD display a similar degree of symptom severity, but the pattern of autonomic function appears to differ between NERD and ERD.

Cited by 25 publications

References 31 publications

Increased Prevalence of Gallstone Disease and Impaired Gallbladder Motility in Patients with Barrett’s Esophagus

Increased Prevalence of Gallstone Disease and Impaired Gallbladder Motility in Patients with Barrett’s Esophagus

Postprandial gastric antral contractions in patients with gastro‐oesophageal reflux disease: a scintigraphic study

Diagnosis and Management of Non-Erosive Reflux Disease – The Vevey NERD Consensus Group

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