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Effect of prolonged gastric distention on lower esophageal sphincter function and gastroesophageal reflux.
Am J Gastroenterol 2003; 98(8):1696-704AJ

Abstract

OBJECTIVES

Morbidly obese patients treated with an intragastric balloon report a transient increase in gastroesophageal reflux (GER) symptoms. In the present study, we evaluated the underlying mechanisms of GER and examined the effect of prolonged gastric distention on lower esophageal sphincter function.

METHODS

Fasting and postprandial manometric studies were performed in obese subjects (n = 15) before, immediately after, and 10 and 20 wk after placement of a 500-ml water-filled balloon.

RESULTS

Residual lower esophageal sphincter (LES) pressure after water swallows was not affected after balloon placement, excluding mechanical interaction with sleeve function. Postprandial LES pressure was significantly increased after 10 and 20 wk. GER was increased in the right recumbent position until 10 wk after balloon placement, mainly because of an increased percentage of transient lower esophageal sphincter relaxations (TLESRs) accompanied by GER. TLESRs were the main mechanisms underlying reflux both before and after balloon placement. The rate of TLESRs was increased significantly immediately after introduction of the balloon, returning to baseline values after 20 wk. After balloon placement, reflux episodes were evoked by gastric contractions that were not inhibited by meals.

CONCLUSIONS

Chronic distention by an intragastric balloon increased reflux up to 10 wk after placement because of an increase in the percentage of TLESRs accompanied by a reflux episode. In addition, prolonged balloon distention increased the rate of TLESRs and created a postprandial state even 10 wk after balloon placement. After 20 wk these effects largely resolved, illustrating adaptation to this artificial situation.

Authors+Show Affiliations

Division of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

12907321

Citation

Hirsch, D P., et al. "Effect of Prolonged Gastric Distention On Lower Esophageal Sphincter Function and Gastroesophageal Reflux." The American Journal of Gastroenterology, vol. 98, no. 8, 2003, pp. 1696-704.
Hirsch DP, Mathus-Vliegen EM, Dagli U, et al. Effect of prolonged gastric distention on lower esophageal sphincter function and gastroesophageal reflux. Am J Gastroenterol. 2003;98(8):1696-704.
Hirsch, D. P., Mathus-Vliegen, E. M., Dagli, U., Tytgat, G. N., & Boeckxstaens, G. E. (2003). Effect of prolonged gastric distention on lower esophageal sphincter function and gastroesophageal reflux. The American Journal of Gastroenterology, 98(8), pp. 1696-704.
Hirsch DP, et al. Effect of Prolonged Gastric Distention On Lower Esophageal Sphincter Function and Gastroesophageal Reflux. Am J Gastroenterol. 2003;98(8):1696-704. PubMed PMID: 12907321.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of prolonged gastric distention on lower esophageal sphincter function and gastroesophageal reflux. AU - Hirsch,D P, AU - Mathus-Vliegen,E M H, AU - Dagli,U, AU - Tytgat,G N J, AU - Boeckxstaens,G E E, PY - 2003/8/9/pubmed PY - 2003/9/30/medline PY - 2003/8/9/entrez SP - 1696 EP - 704 JF - The American journal of gastroenterology JO - Am. J. Gastroenterol. VL - 98 IS - 8 N2 - OBJECTIVES: Morbidly obese patients treated with an intragastric balloon report a transient increase in gastroesophageal reflux (GER) symptoms. In the present study, we evaluated the underlying mechanisms of GER and examined the effect of prolonged gastric distention on lower esophageal sphincter function. METHODS: Fasting and postprandial manometric studies were performed in obese subjects (n = 15) before, immediately after, and 10 and 20 wk after placement of a 500-ml water-filled balloon. RESULTS: Residual lower esophageal sphincter (LES) pressure after water swallows was not affected after balloon placement, excluding mechanical interaction with sleeve function. Postprandial LES pressure was significantly increased after 10 and 20 wk. GER was increased in the right recumbent position until 10 wk after balloon placement, mainly because of an increased percentage of transient lower esophageal sphincter relaxations (TLESRs) accompanied by GER. TLESRs were the main mechanisms underlying reflux both before and after balloon placement. The rate of TLESRs was increased significantly immediately after introduction of the balloon, returning to baseline values after 20 wk. After balloon placement, reflux episodes were evoked by gastric contractions that were not inhibited by meals. CONCLUSIONS: Chronic distention by an intragastric balloon increased reflux up to 10 wk after placement because of an increase in the percentage of TLESRs accompanied by a reflux episode. In addition, prolonged balloon distention increased the rate of TLESRs and created a postprandial state even 10 wk after balloon placement. After 20 wk these effects largely resolved, illustrating adaptation to this artificial situation. SN - 0002-9270 UR - https://www.unboundmedicine.com/medline/citation/12907321/Effect_of_prolonged_gastric_distention_on_lower_esophageal_sphincter_function_and_gastroesophageal_reflux_ L2 - http://Insights.ovid.com/pubmed?pmid=12907321 DB - PRIME DP - Unbound Medicine ER -