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Postprandial cardiac vagal tone and transient lower esophageal sphincter relaxation ( TLESR )
Author(s) -
Kuo P.,
Bravi I.,
Marreddy U.,
Aziz Q.,
Sifrim D.
Publication year - 2013
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/nmo.12195
Subject(s) - postprandial , reflux , medicine , meal , gastroenterology , gerd , reflex , vagal tone , cardiology , vagus nerve , autonomic nervous system , heart rate , blood pressure , stimulation , disease , insulin
Background Transient lower esophageal sphincter relaxation ( TLESR ) is a vagally mediated reflex that occurs most frequently after a meal. Cardiac vagal tone ( CVT ) decreases after a meal, and correlates with changes in gastric electrical activity. Furthermore, decreased CVT has been reported in patients with gastro‐esophageal reflux disease. We therefore aimed to characterize the association between postprandial changes in CVT and the occurrence of TLESR and reflux. Methods Ten healthy volunteers underwent simultaneous autonomic nervous system, gastric myoelectric activity, lower esophageal‐sphincter pressure, and reflux monitoring for 30 min in the fasting state, followed by a standard meal, and a further 4 h postprandially. Results are in mean ± SEM . Key Results The number of TLESR s (P < 0.0001) and reflux episodes (P < 0.0001) increased after the meal, while CVT decreased (P < 0.01). Cardiac sensitivity to baroreceptor reflex ( CSB ) showed similar time course changes to CVT (P = 0.06). During the first postprandial hour there was a strong correlation between the number of TLESR s and reflux episodes with CVT (R 2 = 0.51 and R 2 = 0.50, respectively; P < 0.05). There was also an increase in the dominant power and power ratio on electrogastrography (P < 0.05) after the meal. Conclusions & Inferences In healthy volunteers, the increase in the number of TLESR s and reflux episodes after a meal occurred mostly at a time of reduced CVT . Further studies should explore whether modulation of CVT can modify frequency of TLESR s and also this relationship should be further explored in patients with reflux disease.