Electroesophagogram in gastroesophageal reflux disease with a new theory on the pathogenesis of its electric changes

Abstract

BackgroundIn view of the disturbed esophageal peristaltic activity and abnormal esophageal motility in gastroesophageal reflux disease, (GERD), we investigated the hypothesis that these changes result from a disordered myoelectric activity of the esophagus.MethodsThe electric activity of the esophagus (electroesophagogram, EEG) was studied in 27 patients with GERD (16 men, 11 women, mean age 42.6 ± 5.2 years) and 10 healthy volunteers as controls (6 men, 4 women, mean age 41.4 ± 4.9 years). According to the Feussner scoring system, 7 patients had a mild (score 1), 10 a moderate (score 2) and 10 a severe (score 3) stage of the disease. One electrode was applied to the upper third and a second to the lower third of the esophagus, and the electric activity was recorded. The test was repeated after the upper electrode had been moved to the mid-esophagus.ResultsThe EEG of the healthy volunteers showed slow waves and exhibited the same frequency, amplitude and conduction velocity from the 2 electrodes of the individual subject, regardless of their location in the upper, middle or lower esophagus. Action potentials occurred randomly. In GERD patients, score 1 exhibited electric waves' variables similar to those of the healthy volunteers. In score 2, the waves recorded irregular rhythm and lower variables than the controls. Score 3 showed a "silent" EEG without waves.ConclusionThe electric activity in GERD exhibited 3 different patterns depending on the stages of GERD. Score 1 exhibited a normal EEG which apparently denotes normal esophageal motility. Score 2 recorded irregular electric waves variables which are presumably indicative of decreased esophageal motility and reflux clearance. In score 3, a "silent" EEG was recorded with probably no acid clearance. It is postulated that the interstitial cells of Cajal which are the electric activity generators, are involved in the inflammatory process of GERD. Destruction of these cells appears to occur in grades that are in accordance with GERD scores. The EEG seems to have the potential to act as an investigative tool in the diagnosis of GERD stages.

Manometric study of the lower esophageal sphincter and esophagus in subtotal gastrectomy patients

“…Shafik et al . 2004 58 showed a direct relationship on electroesophagogram between the GERD stage and the deterioration of electrical activity. These findings were attributed to the destruction of the interstitial cells of Cajal, which are electrically active generators that are involved in the inflammatory process of GERD.…”

“…This observation was confirmed by Cerdan et al 2002 57 who observed an improvement in esophageal clearance after fundoplication as a treatment for reflux esophagitis. Shafik et al 2004 58 showed a direct relationship on electroesophagogram between the GERD stage and the deterioration of electrical activity. These findings were attributed to the destruction of the interstitial cells of Cajal, which are electrically active generators that are involved in the inflammatory process of GERD.…”

On the origin of rhythmic contractile activity of the esophagus in early achalasia, a clinical case study

“…In the rat fundus (Powley et al, 2008) as well as in the cat esophagus (Huizinga et al, 2008), ICC-IM have been shown to be part of the vagal afferent pathway and were suggested to be a critical part of the vagal mechanoreceptors, the intramuscular arrays (IMA), indicating that direct communication between vagal nerves and ICC is possible. Shafik recorded a stable rhythmic electrical activity in the esophagus of volunteers using mucosal suction electrodes, at a frequency of 4–7 min and a propagation velocity of 3–6 cm/s (Shafik et al, 2004). The frequency increased upon esophageal balloon distention to 9/min (Shafik et al, 2005).…”

Ineffective esophageal motility and the vagus: current challenges and future prospects

“… 26 – 28 This may be similar in the esophagus where regular slow-wave activity at four to seven cycles per minute has been recorded in healthy volunteers, propagating at 4–6 cm/s. 29 The close association between nitrergic nerves and intramuscular ICC would suggest that they may become reduced simultaneously in achalasia; however, this was not observed; in patients with severe reduction of nitrergic nerves, ICC could be structurally normal. 23 This appeared to confirm that nitrergic nerves are primarily responsible for the propagating nature of the esophageal contraction.…”