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The gastric accommodation response to meal intake determines the occurrence of transient lower esophageal sphincter relaxations and reflux events in patients with gastro‐esophageal reflux disease
Author(s) -
Pauwels A.,
Altan E.,
Tack J.
Publication year - 2014
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.12305
Subject(s) - postprandial , gerd , reflux , medicine , gastroenterology , high resolution manometry , esophagus , esophageal sphincter , gastric emptying , meal , stomach , disease , insulin
Background Gastro‐esophageal reflux ( GER ), the retrograde flow of gastric contents into the esophagus is a physiologic phenomenon, which can evoke symptoms and/or lesions in the esophagus (=gastro‐esophageal reflux disease or GERD ). Proton pump inhibitors ( PPI s) reduce gastric acidity; however, as they are unable to control transient lower esophageal sphincter relaxations ( TLESR s), the main mechanism for reflux in GERD , they do not abolish reflux. TLESR s occur predominantly in the postprandial period, and they are believed to be triggered by gastric distention. Gastric accommodation ( GA ) is the physiologic response to gastric distention and serves to prevent a rise in gastric wall tension during food intake. We aimed to study the relationship between GA and TLESR s, as they both are triggered by gastric distention. Methods We studied 12 GERD patients (average age 37 years [range 18–62], 7m/5f) and nine healthy volunteers (average age 27 years [range 22–36], 2m/7f) using high resolution manometry‐impedance measurement before and after a mixed meal challenge. We determined the number of TLESR s (with or without reflux) and measured pre‐ and postprandial IGP . The change in IGP between the pre‐ and postprandial period (Δ IGP ) is used as surrogate for GA . We also measured LES pressure before and after the meal and calculated the change (Δ LES p). Key Results There were no statistical differences between pre‐ and postprandial IGP in GERD and healthy volunteers and similarly, there was no significant difference between pre‐ and postprandial LES pressures in GERD patients and healthy volunteers. The number of TLESR s (with or without reflux) was similar in GERD and healthy volunteers. More importantly, we did observe a negative correlation between Δ IGP and the number of TLESR s, irrespective of whether they were associated with reflux or not, in the GERD patients (without reflux r = −0.67, p = 0.017; with reflux r = −0.81, p = 0.0014). The same observations were found in healthy volunteers, where Δ IGP and the number of TLESR s are significantly inversely correlated (without reflux r = −0.87, p = 0.0045; with reflux r = −0.75, p = 0.021). We could not establish a correlation between Δ LES p and the number of TLESR s, neither in GERD patients nor in healthy volunteers. Conclusions & Inferences This is the first study showing a clear negative correlation between Δ IGP and the number of TLESR s, irrespective of whether they were associated with reflux or not, both in GERD patients and in healthy subjects. These results suggest that TLESR s and GA are closely linked, probably through activation of mechanoreceptors involved in triggering of TLESR s.