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Upper sphincter function during transient lower oesophageal sphincter relaxation (tLOSR); it is mainly about microburps
Author(s) -
Pandolfino J. E.,
Ghosh S. K.,
Zhang Q.,
Han A.,
Kahrilas P. J.
Publication year - 2007
Publication title -
neurogastroenterology and motility
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.489
H-Index - 105
eISSN - 1365-2982
pISSN - 1350-1925
DOI - 10.1111/j.1365-2982.2006.00882.x
Subject(s) - high resolution manometry , reflux , medicine , relaxation (psychology) , gastroenterology , sphincter , esophageal sphincter , heartburn , reflex , surgery , disease
Transient lower oesophageal sphincter relaxations (tLOSRs) are both a dominant mechanism of reflux and an element of the belch reflex. This study aimed to analyse the interplay between reflux and upper oesophageal sphincter (UOS) activity during meal‐induced tLOSRs. Fifteen normal subjects were studied with a solid‐state high‐resolution manometry assembly positioned to record from the hypopharynx to the stomach and a catheter pH electrode 5 cm above the LOS. Subjects ate a 1000‐calorie high‐fat meal and were monitored for 120 min in a sitting posture. The relationship among tLOSRs, common cavities, pressure changes within the oesophagus and UOS contractile activity were analysed. A total of 218 tLOSRs occurred among the 15 subjects. The majority (79%) were coupled with UOS relaxation and 84% (145/173) of these occurred in association with a common cavity. Upper oesophageal sphincter relaxation was usually preceded by a pressure change in the oesophagus; however, some relaxations (16%) occurred without a discernable increase in pressure or before the pressure increase began. Acid reflux did not appear to play a role in determining UOS response to tLOSRs. The majority of post‐prandial tLOSRs were associated with brief periods of UOS relaxation, likely permissive of gas venting (microburps). Intraoesophageal pressure changes likely modulate this UOS response; however, an anticipatory characteristic was evident in some subjects. Whether or not GORD patients with extra‐oesophageal symptoms exhibit an exaggeration of the UOS relaxation response during reflux is yet to be determined.