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Am J Physiol Gastrointest Liver Physiol 284: G242-G247, 2003. First published October 16, 2002; doi:10.1152/ajpgi.00301.2002
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Vol. 284, Issue 2, G242-G247, February 2003

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

Philippe Pouderoux1, Eric Verdier1, and Peter J. Kahrilas2

1 Service d'Hépato-Gastroentérologie et Alcoologie, Hôpital Caremeau, Centre Hospitalier et Universitaire de Nîmes, 30900 France; and 2 Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611-3008

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).

esophageal primary peristalsis; transient LES relaxation; gastroesophageal reflux; pharynx; swallow


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