Patterns of esophageal inhibition during swallowing, pharyngeal stimulation, and transient LES relaxation. Lower esophageal sphincter

Lower esophageal sphincter (LES) relaxation and esophageal body inhibition co-occur during esophageal peristalsis but not necessarily during pharyngeal stimulation or transient LES relaxation (tLESR). This study examined these relationships and the impact on reflux. Nine young volunteers were studie...

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Bibliographic Details
Published in:American journal of physiology: Gastrointestinal and liver physiology 2003-02, Vol.284 (2), p.G242-G247
Main Authors: Pouderoux, Philippe, Verdier, Eric, Kahrilas, Peter J
Format: Article
Language:English
Subjects:
Adolescent
Adult
Catheterization
Deglutition - physiology
Diaphragm - physiology
Esophagogastric Junction - physiology
Esophagus - physiology
Female
Gastroesophageal Reflux - physiopathology
Humans
Male
Manometry
Muscle Relaxation - physiology
Peristalsis - physiology
Pharynx - physiology
Physical Stimulation
Pressure
Stomach - physiology
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Summary:Lower esophageal sphincter (LES) relaxation and esophageal body inhibition co-occur during esophageal peristalsis but not necessarily during pharyngeal stimulation or transient LES relaxation (tLESR). This study examined these relationships and the impact on reflux. Nine young volunteers were studied. An artificial high-pressure zone (HPZ) was established, and pH was recorded 8 and 5 cm proximal to the LES. Pharyngeal stimulation was by water injection and gastric distension with liquid or gas. Peristalsis, pharyngeal stimulation, and spontaneous events were recorded. Swallowing relaxed the LES in 100% of trials (the HPZ in 80%) and caused no reflux. Pharyngeal stimulation relaxed the LES in two-thirds of trials, had no effect on the HPZ, and caused no reflux. Gastric distension was associated with 117 tLESRs, 48% with acid reflux, and 32% with gas reflux; there was no effect on the HPZ. We conclude that LES relaxation is a necessary but not sufficient condition for reflux. LES relaxation and esophageal body inhibition are independent events that may be concurrent (swallowing) or dissociated (tLESR).
ISSN:0193-1857