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Am J Physiol Gastrointest Liver Physiol 284: G815-G820, 2003; doi:10.1152/ajpgi.00247.2002
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Vol. 284, Issue 5, G815-G820, May 2003

Reduced tLESR elicitation in response to gastric distension in fundoplication patients

R. C. H. Scheffer1,2, R. P. Tatum2, G. Shi2, L. M. A. Akkermans1, R. J. Joehl2, and P. J. Kahrilas2

1 Gastrointestinal Research Unit, Departments of Surgery and Gastroenterology, University Medical Center, 3508 GA Utrecht, The Netherlands; and 2 Departments of Medicine and Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois 60611

Transient lower esophageal sphincter relaxations (tLESRs) are vagally mediated in response to gastric cardiac distension. Nine volunteers, eight gastroesophageal reflux disease (GERD) patients, and eight fundoplication patients were studied. Manometry with an assembly that included a barostat bag was done for 1 h with and 1 h without barostat distension to 8 mmHg. Recordings were scored for tLESRs and barostat bag volume. Fundoplication patients had fewer tLESRs (0.4 ± 0.3/h) than either normal subjects (2.4 ± 0.5/h) or GERD patients (2.0 ± 0.3/h). The tLESRs rate increased significantly in normal subjects (5.8 ± 0.9/h) and GERD patients (5.4 ± 0.8/h) during distension but not in the fundoplication group. All groups exhibited similar gastric accommodation (change in volume/change in pressure) in response to distension. Fundoplication patients exhibit a lower tLESR rate at rest and a marked attenuation of the response to gastric distension compared with either controls or GERD patients. Gastric accommodation was not impaired with fundoplication. This suggests that the receptive field for triggering tLESRs is contained within a wider field for elicitation of gastric receptive relaxation and that only the first is affected by fundoplication.

barostat; transient lower esophageal sphincter relaxation


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