Sustained esophageal contraction: a motor correlate of heartburn symptom

Pehlivanov, Nonko; Liu, Jianmin; Mittal, Ravinder K.

doi:10.1152/ajpgi.2001.281.3.g743

Cited by 143 publications

(113 citation statements)

References 28 publications

(19 reference statements)

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“…In addition, the acid-neutralizing function of esophageal cardiac glands may not be strong enough to prevent the occurrence of GERD symptoms. Furthermore, several other mechanisms may also influence the development of GERD symptoms, as such symptoms have also been reported to be caused by non-acidic and gas reflux, duodenal juice reflux, esophageal hypersensitivity to acid, esophageal wall distension, esophageal motility abnormalities, sustained esophageal contractions, psychological conditions and others (18)(19)(20)(21)(22)(23)(24).…”

Section: Discussionmentioning

confidence: 99%

Relationship between Esophageal Cardiac Glands and Gastroesophageal Reflux Disease

et al. 2015

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Objective The role of esophageal cardiac glands has not been fully determined. This study was performed to clarify the protective role of esophageal cardiac glands against the development of gastroesophageal reflux disease (GERD). Methods The subjects included 2,656 Japanese individuals who visited our institution for a detailed medical checkup. GERD symptoms were assessed using the Japanese version of the Carlsson-Dent selfadministered questionnaire (QUEST) and an upper gastrointestinal endoscopy examination in each subject. The presence of reflux esophagitis, size of diaphragmatic hiatus, degree of gastric mucosal atrophy and existence of visible esophageal cardiac glands in the distal esophagus, based on the detection of yellowish elevated areas, were determined using endoscopy. Results Esophageal cardiac glands were observed in 355 cases (13.4%). Reflux esophagitis was significantly less frequent in the cases with esophageal cardiac glands than in those without. The esophageal cardiac glands were mainly located on the left-posterior side of the esophageal wall of the distal esophagus. A multiple regression analysis showed that the presence of esophageal cardiac glands was an independent factor for preventing reflux esophagitis. On the other hand, the existence of these glands did not correlate with the presence of GERD symptoms (QUEST score of 6 or more). Conclusion The presence of visible esophageal cardiac glands may have a protective role against the development of reflux esophagitis.

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Section: Discussionmentioning

confidence: 99%

Relationship between Esophageal Cardiac Glands and Gastroesophageal Reflux Disease

et al. 2015

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“…In addition, the same symptom can be produced by a physiological intraesophageal acid exposure [7]. Increased esophageal sensitivity to esophageal distension or stimulation [8,9,10,11], non-acid reflux [12, 13], and esophageal motor abnormalities [14] are suggested to play a role in the genesis of heartburn. Based on ambulatory esophageal pH monitoring, patients with no evidence of esophagitis on endoscopy can be subdivided as having excessive or normal esophageal acid exposure time.…”

Section: Discussionmentioning

confidence: 99%

Demographic, Clinical, and Psychological Characteristics of the Heartburn Groups Classified Using the Rome III Criteria and Factors Associated with the Responsiveness to Proton Pump Inhibitors in the Gastroesophageal Reflux Disease Group

et al. 2009

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Background/Aims: The diagnostic criteria for nonerosive reflux disease (NERD) and functional heartburn (FH) have been changed. We investigated demographic, clinical, and psychological characteristics of the heartburn groups classified using the Rome III criteria and factors associated with the responsiveness to proton pump inhibitors (PPIs) in the gastroesophageal reflux disease (GERD) group. Methods: Ninety-five patients with heartburn underwent endoscopy, 24-hour esophageal pH-metry and then a PPI test. NERD was diagnosed when % time with pH <4 was >4%, a symptom index (SI) ≥50% or a positive PPI test in patients without erosive esophagitis. Patients without such findings were classified as FH. Results: Thirty-six patientshad erosive reflux disease (ERD), 36 had NERD, and 23 had FH. The proportion of males was significantly higher in ERD than in FH. Atypical symptoms and IBS were more prevalent in FH than in ERD. Anxiety was more prevalent in FH than in NERD. The prevalence of pathologic acid reflux, a positive SI and a positive PPI test was similar between ERD and NERD patients. In the ERD and NERD groups, depression was independently associated with nonresponsiveness to PPIs. Conclusions: FH is a different entity from ERD or NERD, particularly in terms of gender, acid reflux patterns, psychological profiles, and the responsiveness to PPIs.

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“…In their pioneering work, Mittal and colleagues also demonstrated an association between episodes of noncardiac chest pain and sustained contraction of the longitudinal muscle layer. This was a hitherto unrecognized esophageal motor event that provided a potential explanation for chest pain in these patients in the absence of reflux or abnormal contraction of the circular muscle (12,14).…”

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confidence: 86%

Esophageal Ultrasonography: A New View on Esophageal Motility

Holloway¹

2007

Am J Gastroenterol

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Esophageal manometry has long been the gold standard for assessment of esophageal motility. Recently, high-frequency intraluminal ultrasonography (HFIUS) has been introduced to measure esophageal contractility and the thickness of esophageal muscle. Greater esophageal muscle thickness has been reported in patients with achalasia, diffuse spasm, and hypertensive peristalsis. In this issue of the Journal, Mittal and colleagues report additional observations in patients with esophageal symptoms referred for esophageal manometry. Their findings confirm earlier observations in patients with spastic motor disorders and report new findings of greater muscle thickness in patients with nonspecific motor disorders as well as normal manometry. Greater muscle thickness was associated with a greater prevalence of dysphagia suggesting the possibility that symptoms may be related, at least in part, to alterations in the biomechanics of the esophagus. The place of HFIUS in the assessment of esophageal function remains to be determined, but it offers the possibility of greater insights into esophageal physiology as well as clinical esophageal motor disorders. (Am J Gastroenterol 2007;102:146-148)Intraluminal manometry has been the gold standard for assessment of esophageal motor function for over 50 yr. Arguably, it has probably contributed more to our understanding of esophageal motility and esophageal motor disorders than any other single measurement modality. Currently, definitions of esophageal motor disorders are based primarily on the manometric features and the patterns of abnormal peristaltic and lower esophageal sphincter (LES) function. Other modalities, such as barium radiology and radionuclide scintigraphy, have forged useful but complementary roles. However, their usefulness and diagnostic specificity are limited by their radiation exposure, qualitative nature, and lack of specific features for all individual motor disorders.Maintenance of the primary position of manometry in the assessment of esophageal motility has been helped by a number of improvements in manometric methodology. These include the development of high-fidelity recording systems, multiple recording sites that allow for recording from the entire esophagus simultaneously, and the sleeve sensor for continuous recording of sphincter pressure. Most recently, the development of high-resolution manometry and topographical displays has yielded new perspectives on and insights into esophageal motor function (1, 2). Perhaps, the most important of these as the recognition that esophageal peristalsis is not a single propagated wave but a composite of two if not three separate sequences that are organizationally separate but temporally and functionally coordinated to yield a propagated pressure wave that traverses the whole esophagus. Whether such detailed mapping of esophageal motility improves the diagnostic utility of manometry over that already available from conventional 8-channel sleeve manometry remains to be demonstrated (3, 4), although it clearly offe...

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Sustained esophageal contraction: a motor correlate of heartburn symptom

Cited by 143 publications

References 28 publications

Relationship between Esophageal Cardiac Glands and Gastroesophageal Reflux Disease

Relationship between Esophageal Cardiac Glands and Gastroesophageal Reflux Disease

Demographic, Clinical, and Psychological Characteristics of the Heartburn Groups Classified Using the Rome III Criteria and Factors Associated with the Responsiveness to Proton Pump Inhibitors in the Gastroesophageal Reflux Disease Group

Esophageal Ultrasonography: A New View on Esophageal Motility

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