Mechanism of gastroesophageal reflux in recumbent asymptomatic human subjects.

Abstract

A B S T R A C T We investigated the mechanism of gastroesophageal reflux (GER) in 10 healthy volunteer subjects. Continuous recordings of intraluminal esophageal pH and pressure were obtained on two consecutive nights from 6:00 p.m. to 6:30 a.m. in each subject. During each study, the subject remained recumbent, except to eat a standardized meal after 1 h of basal recording. A manometric assembly with seven recording lumens monitored: (a) lower esophageal sphincter (LES) pressure via a sleeve device 6.5 cm in length, (b) esophageal-body motor activity, (c) swallowing activity in the pharynx, and (d) gastric pressure. An electrode 5 cm above the LES recorded esophageal pH. Sleep was monitored by electroencephalogram. All subjects showed wide variations ofbasal LES pressure. GER was not related to low steady-state basal LES pressure, but rather occurred during transient 5-30 s episodes of inappropriate complete LES relaxation. The inappropriate LES relaxations were usually either spontaneous or immediately followed appropriate sphincter relaxation induced by swallowing. The majority of GER episodes occurred within the first 3 h after eating. During the night LES relaxation and GER occurred only during transient arousals from sleep or when the subjects were fully awake, but not during stable sleep. After GER the esophagus was generally cleared of refluxed acid by primary peristalsis and less frequently by secondary peristalsis. Nonperistaltic contractions were less effective than peristalsis for clearing acid from the esophagus. We conclude that in asympto-A preliminary communication of this work was abstracted in 1978 (Gastroenterology. 74: 1119.) and was presented at the

Postmenopausal Hormone Use and Symptoms of Gastroesophageal Reflux

“…11 Postmenopausal use of estrogens is associated with increased plasma NO levels 20 , and NO is a principal neurotransmitter for relaxation of the lower esophageal sphincter. 21 NO is also associated with transient relaxations of the lower esophageal sphincter 22 , one of the primary mechanisms underlying gastroesophageal reflux in healthy volunteers 23 and patients with reflux esophagitis. 24 Previously, it has been shown that postmenopausal women taking unopposed estrogen had higher plasma NO levels than women taking the same dose of estrogen coupled with the progestin levonorgestrel.…”

Estudo comparativo do pH e do volume salivar em indivíduos com laringofaringite crônica por doença do refluxo gastroesofágica antes e após o tratamento

“…According to some authors, estimates as to acid reflux causing posterior laryngitis vary greatly, coming up to 80% of the cases 14,33 . This causal relationship has increased thanks to the technological development of devices capable of measuring the proximal and distal stomach acidity and that of the pharynx 13,21,[34][35][36][37][38][39][40] , we also have optic fibers which are broadly used in clinical practice, and they do facilitate viewing the larynx 19,20 . We still do not know, exactly, how many reflux episodes are necessary to produce inflammatory changes and larynx lesions.…”

O esôfago curto e o refluxo distal são fatores de risco para o refluxo proximal?

“…Some causes have been proposed, such as the incompetence of the LES 14 , the transient lower esophageal sphincter relaxation 4,5,10 and the deficiency of the esophageal body motility 7 .…”