Mechanisms of lower oesophageal sphincter incompetence in patients with symptomatic gastrooesophageal reflux.

Abstract

SUMMARY Patterns of lower oesophageal sphincter (LOS) function associated with the onset of 644 reflux episodes were recorded and analysed in 67 patients referred for evalution of gastrooesophageal reflux (GOR). Patients were studied recumbent, for one hour before and four hours after a standard meal. Transient LOS relaxation was the most prevalent mechanism and overall accounted for 82% of reflux episodes. With increasing severity of oesophagitis, absent basal LOS pressure became a progressively more common mechanism, accounting for 23% of episodes in the patients with severe oesophagitis. Patients commonly exhibited more than one mechanism. The timing of most (69%) LOS relaxations associated with reflux was not compatible with triggering by swallowing. Prolonged transient LOS relaxations were associated with inhibition of oesophageal peristalsis suggesting that this response is produced by neural inhibition. This study suggests the primary importance of transient LOS relaxations as the cause of GOR across the spectrum of severity of reflux disease.For many years gastrooesophageal reflux (GOR) was generally believed to result from lower oesophageal sphincter (LOS) incompetence caused by defective basal LOS tone.'`This concept, however, fails to account for the substantial proportion of patients with reflux disease in whom resting LOS pressure is normal.7 A recent study has shown that GOR in normal subjects occurs almost exclusively as a result of transient LOS relaxation, rather than from defective basal LOS pressure.8 In a subsequent study of 10 selected patients with erosive peptic oesophagitis, transient LOS relaxation accounted for 65% of reflux episodes, the remainder of reflux episodes occurring during prolonged periods of absent or low basal LOS pressure.9 The aims of the present study were to: (a) investigate possible variation in the mechanisms of GOR within a large group of patients exhibiting a spectrum of severity of reflux disease: and (b) analyse in detail, patterns of oeso-

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.…”

Pressure profile along the oesophagus during eructation in sheep

“…Continuous recording of intraluminal oesophageal pressure by a low compliance side-hole manometric assembly perfusion system shows that the pressure events related to eructation did not differ significantly from those recorded in man or in dog during gaseous distension of the stomach (Patriokios et al, 1986;Dent ei al, 1988). The major difference was the amplitude of the pressure plateau which was almost similar to that of the caudally propagated peristaltic wave, whereas in man the amplitude of the pressure plateau was about 1/10 that of the caudally propagated peristaltic wave (Dent et al, 1988;Holloway et al, 1989).…”

“…Le débit aérien au cours de l'éructation dépend de la position de la tête qui modifie la tension de la paroi de l'cesophage. En (Dent et al, 1988). The competence of the LOS to prevent reflux of gastric acidic chyme or gas into the oesophagus is clinically evaluated by measurement of its basal pressure (Patriokios et al, 1986;Mittal et al, 1990) (Ali and Singleton, 1979).…”

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 .…”