Motor activity of the distal oesophagus and gastrooesophageal reflux.

Abstract

SUMMARY The relationship between intraoesophageal pH value and motor activity of the lower oesophageal body ard sphincter was in-vvstigated by simultaneous evaluation of intraluminal pressure and pH in 13 patients complaining of heartburn and regurgitation. One hundred and thirty one episodes of gastro-oesophageal reflux were recorded. One hundred and eighteen (90.1%) were preceded by a swallow (one to 12 seconds), 13 reflux episodes (9.9%) were not preceded by a swallow. Gastro-oesophageal refluxes preceded by swallow were accompanied by an equal number of normal and abnormal primary peristaltic sequences and, while recording at level of the lower oesophageal sphincter, occurred during inhibition of the sphincter. Frequency of abnormal primary peristalsis increased (p<0.01) during periods of low intraluminal pH (<5 0). An increase of at least 0 5 U in intraluminal pH occurred with 45 2% of normal primary peristalsis, 29-3% of abnormal primary peristalsis, 4*3% of secondary peristalsis, 3.5% of non-peristaltic contractions. The results of this study indicate that in patients with symptoms of reflux oesophagitis, gastro-oesophagel reflux appears to be related to swallow-induced lower oesophageal sphincter inhibition and not related to abnormal motor activity of the distal oesophageal body where an increased frequency of abnormal primary peristalsis appears to occur during low intraluminal pH and primary peristalsis appears to be the most important mechanism of oesophageal clearing.

Correlation between Endoscopic and pH-Metric Findings and Motor Oesophageal Alterations in Reflux Oesophagitis

“…Our findings are similar to those described by other authors [7,[9][10][11][12][13][14][15], and suggest that the minimal or slight inflammatory changes in oesophageal mucosa cause a state of irritability with a tendency towards spastic con tractions of the oesophageal musculature, whereas severe inflammation leads to a decrease and, in some cases, a total loss of muscle contractability. These alterations lead to a poor clearance of refluxed material, which increases the duration of acid exposure of oesophageal mucosa, as was confirmed in our pH-metric study.…”

“…However, there is less information available on the role played by oesophageal motor alterations in the pathogenesis of this disease and even controversy on the subject. Thus, while some authors [7,[9][10][11][12][13][14][15] claim that peristaltic dysfunction is secondary to gastro-oesophageal reflux, others [8,[16][17][18][19] believe that it is a primary motor disorder forming part of a multifactorial aetiology.…”

The Effect of Antireflux Operations on Lower Oesophageal Sphincter Tone and Postprandial Symptoms

“…Complete sphincter relaxation usually follows a swallow, and since these events occur frequently in the awake state, it has been suggested that up to 40% of reflux episodes are associated with swallowing-induced sphincter relaxations. On the other hand, considerably lower figures for these associations have been presented by investigators using reliable recording techniques (2)(3)(4)(5)(6)(7)(8). It appears that swallow-induced reflux episodes are more likely to be associated with defective oesophageal peristalsis ( 2 , S ) and are common in patients with hiatus hernia ( 9 , 10).…”

Effect of White Wine on Esophageal Peristalsis and Acid Clearance

“…A separate analysis was performed for the number of complete peristaltic contraction waves needed to increase esophageal pH above 5. For this analysis, swallows with failed peristalsis, low-amplitude contractions, and simultaneous contractions were not counted since these types of contractions insuf -ciently clear re ux (16,17,(28)(29)(30)(31). A failed peristalsis was de ned as no contraction response in the esophagus after a pharyngeal swallow signal or a disappearance of the peristaltic sequence in the distal part of the esophagus.…”