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Mechanisms of gastroesophageal acid reflux and esophageal acid clearance in heartburn patients.
Am J Gastroenterol. 1996 Sep; 91(9):1739-44.AJ

Abstract

OBJECTIVES

Gastroesophageal reflux can occur because of low resting pressure, transient relaxation, or normal relaxation of the lower esophageal sphincter. Mechanisms for delayed esophageal clearance include impaired peristalsis, infrequent swallowing, and impaired sphincter relaxation. The purpose of this study was to examine esophageal function in patients with gastroesophageal reflux and to determine esophageal acid clearance.

METHODS

Esophageal contractile pressure, duration, velocity, pH, sphincter pressure, and deglutition were monitored in 12 heartburn patients 1 h before and 3 h postprandially twice.

RESULTS

Eighty-seven episodes of gastroesophageal reflux occurred during normal sphincter relaxation, and 72 episodes occurred during transient sphincter relaxation; however, the frequency with normal sphincter relaxations was quite low (1%) compared with transient sphincter relaxations (33%). Mean and median esophageal acid exposure was not different during normal sphincter relaxation (71 and 80 s) compared with during transient sphincter relaxation (71 and 81 s). There were 284 instances of primary peristalsis, with 157 resulting in esophageal acid clearance, compared with simultaneous contractions (6 of 66), secondary peristalsis (1 of 7), and tertiary contractions (0 of 45). Contractile pressures were higher and durations were longer with acid clearance, but velocities were not different.

CONCLUSIONS

Frequency of gastroesophageal reflux is the same during normal and transient sphincter relaxation in heartburn patients. Primary peristalsis is necessary to accomplish acid clearance. Secondary peristalsis is rare and ineffective.

Authors+Show Affiliations

Division of Gastroenterology, Presbyterian Medical Center of Philadelphia, University of Pennsylvania School of Medicine, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

8792691

Citation

Allen, M L., et al. "Mechanisms of Gastroesophageal Acid Reflux and Esophageal Acid Clearance in Heartburn Patients." The American Journal of Gastroenterology, vol. 91, no. 9, 1996, pp. 1739-44.
Allen ML, Castell JA, DiMarino AJ. Mechanisms of gastroesophageal acid reflux and esophageal acid clearance in heartburn patients. Am J Gastroenterol. 1996;91(9):1739-44.
Allen, M. L., Castell, J. A., & DiMarino, A. J. (1996). Mechanisms of gastroesophageal acid reflux and esophageal acid clearance in heartburn patients. The American Journal of Gastroenterology, 91(9), 1739-44.
Allen ML, Castell JA, DiMarino AJ. Mechanisms of Gastroesophageal Acid Reflux and Esophageal Acid Clearance in Heartburn Patients. Am J Gastroenterol. 1996;91(9):1739-44. PubMed PMID: 8792691.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mechanisms of gastroesophageal acid reflux and esophageal acid clearance in heartburn patients. AU - Allen,M L, AU - Castell,J A, AU - DiMarino,A J,Jr PY - 1996/9/1/pubmed PY - 2001/3/28/medline PY - 1996/9/1/entrez SP - 1739 EP - 44 JF - The American journal of gastroenterology JO - Am J Gastroenterol VL - 91 IS - 9 N2 - OBJECTIVES: Gastroesophageal reflux can occur because of low resting pressure, transient relaxation, or normal relaxation of the lower esophageal sphincter. Mechanisms for delayed esophageal clearance include impaired peristalsis, infrequent swallowing, and impaired sphincter relaxation. The purpose of this study was to examine esophageal function in patients with gastroesophageal reflux and to determine esophageal acid clearance. METHODS: Esophageal contractile pressure, duration, velocity, pH, sphincter pressure, and deglutition were monitored in 12 heartburn patients 1 h before and 3 h postprandially twice. RESULTS: Eighty-seven episodes of gastroesophageal reflux occurred during normal sphincter relaxation, and 72 episodes occurred during transient sphincter relaxation; however, the frequency with normal sphincter relaxations was quite low (1%) compared with transient sphincter relaxations (33%). Mean and median esophageal acid exposure was not different during normal sphincter relaxation (71 and 80 s) compared with during transient sphincter relaxation (71 and 81 s). There were 284 instances of primary peristalsis, with 157 resulting in esophageal acid clearance, compared with simultaneous contractions (6 of 66), secondary peristalsis (1 of 7), and tertiary contractions (0 of 45). Contractile pressures were higher and durations were longer with acid clearance, but velocities were not different. CONCLUSIONS: Frequency of gastroesophageal reflux is the same during normal and transient sphincter relaxation in heartburn patients. Primary peristalsis is necessary to accomplish acid clearance. Secondary peristalsis is rare and ineffective. SN - 0002-9270 UR - https://www.unboundmedicine.com/medline/citation/8792691/Mechanisms_of_gastroesophageal_acid_reflux_and_esophageal_acid_clearance_in_heartburn_patients_ L2 - http://www.diseaseinfosearch.org/result/2996 DB - PRIME DP - Unbound Medicine ER -