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Transient lower oesophageal sphincter relaxations--a pharmacological target for gastro-oesophageal reflux disease?
Aliment Pharmacol Ther. 2002 Jan; 16(1):17-26.AP

Abstract

The oesophago-gastric junction functions as an anti-reflux barrier preventing increased exposure of the oesophageal mucosa to gastric contents. Failure of this anti-reflux barrier results in gastro-oesophageal reflux disease, and may lead to complications such as oesophagitis, Barrett's oesophagus and eventually oesophageal carcinoma. Recent studies have suggested that transient lower oesophageal sphincter relaxation is the main mechanism underlying gastro-oesophageal reflux. It involves a prolonged relaxation of the lower oesophageal sphincter, mediated by a vago-vagal neural pathway, synapsing in the brainstem. Several drugs, such as atropine, baclofen and loxiglumide, have been shown to reduce the rate of transient lower oesophageal sphincter relaxations and concomitantly the number of reflux episodes. These findings illustrate that transient lower oesophageal sphincter relaxations may represent a potential new target for the pharmacological treatment of gastro-oesophageal reflux disease. It is possible that the reduction in the number of transient lower oesophageal sphincter relaxations may also contribute to the beneficial effect of fundoplication and new endoscopic anti-reflux procedures. It should be emphasized, however, that other factors, such as low lower oesophageal sphincter pressure, the presence of a hiatal hernia and impaired oesophageal peristalsis, are also of great importance. Therefore, whether the targeting of transient lower oesophageal sphincter relaxations is the 'golden bullet' in anti-reflux therapy remains to be proven, as evidence of an effective control of gastro-oesophageal reflux in reflux patients is still lacking.

Authors+Show Affiliations

Academic Medical Centre, Division of Gastroenterology and Hepatology, Amsterdam, The Netherlands.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

11856074

Citation

Hirsch, D P., et al. "Transient Lower Oesophageal Sphincter Relaxations--a Pharmacological Target for Gastro-oesophageal Reflux Disease?" Alimentary Pharmacology & Therapeutics, vol. 16, no. 1, 2002, pp. 17-26.
Hirsch DP, Tytgat GN, Boeckxstaens GE. Transient lower oesophageal sphincter relaxations--a pharmacological target for gastro-oesophageal reflux disease? Aliment Pharmacol Ther. 2002;16(1):17-26.
Hirsch, D. P., Tytgat, G. N., & Boeckxstaens, G. E. (2002). Transient lower oesophageal sphincter relaxations--a pharmacological target for gastro-oesophageal reflux disease? Alimentary Pharmacology & Therapeutics, 16(1), 17-26.
Hirsch DP, Tytgat GN, Boeckxstaens GE. Transient Lower Oesophageal Sphincter Relaxations--a Pharmacological Target for Gastro-oesophageal Reflux Disease. Aliment Pharmacol Ther. 2002;16(1):17-26. PubMed PMID: 11856074.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transient lower oesophageal sphincter relaxations--a pharmacological target for gastro-oesophageal reflux disease? AU - Hirsch,D P, AU - Tytgat,G N J, AU - Boeckxstaens,G E E, PY - 2002/2/22/pubmed PY - 2002/3/20/medline PY - 2002/2/22/entrez SP - 17 EP - 26 JF - Alimentary pharmacology & therapeutics JO - Aliment Pharmacol Ther VL - 16 IS - 1 N2 - The oesophago-gastric junction functions as an anti-reflux barrier preventing increased exposure of the oesophageal mucosa to gastric contents. Failure of this anti-reflux barrier results in gastro-oesophageal reflux disease, and may lead to complications such as oesophagitis, Barrett's oesophagus and eventually oesophageal carcinoma. Recent studies have suggested that transient lower oesophageal sphincter relaxation is the main mechanism underlying gastro-oesophageal reflux. It involves a prolonged relaxation of the lower oesophageal sphincter, mediated by a vago-vagal neural pathway, synapsing in the brainstem. Several drugs, such as atropine, baclofen and loxiglumide, have been shown to reduce the rate of transient lower oesophageal sphincter relaxations and concomitantly the number of reflux episodes. These findings illustrate that transient lower oesophageal sphincter relaxations may represent a potential new target for the pharmacological treatment of gastro-oesophageal reflux disease. It is possible that the reduction in the number of transient lower oesophageal sphincter relaxations may also contribute to the beneficial effect of fundoplication and new endoscopic anti-reflux procedures. It should be emphasized, however, that other factors, such as low lower oesophageal sphincter pressure, the presence of a hiatal hernia and impaired oesophageal peristalsis, are also of great importance. Therefore, whether the targeting of transient lower oesophageal sphincter relaxations is the 'golden bullet' in anti-reflux therapy remains to be proven, as evidence of an effective control of gastro-oesophageal reflux in reflux patients is still lacking. SN - 0269-2813 UR - https://www.unboundmedicine.com/medline/citation/11856074/Transient_lower_oesophageal_sphincter_relaxations__a_pharmacological_target_for_gastro_oesophageal_reflux_disease L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0269-2813&date=2002&volume=16&issue=1&spage=17 DB - PRIME DP - Unbound Medicine ER -