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This Article Full Text Full Text (PDF) All Versions of this Article: 297/1/G71    most recent 00017.2009v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Kuribayashi, S. Articles by Shaker, R. PubMed PubMed Citation Articles by Kuribayashi, S. Articles by Shaker, R.

NEUROREGULATION AND MOTILITY

Terminating motor events for TLESR are influenced by the presence and distribution of refluxate

¹Dysphagia Institute, Division of Gastroenterology and Hepatology and Departments of ²Otolaryngology and ³Sleep Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin

Submitted 13 January 2009 ; accepted in final form 14 May 2009

Transient lower esophageal sphincter relaxation (TLESR) is frequently associated with reflux events and terminates with a primary or secondary peristaltic wave. However, it is unclear whether the presence and properties of the refluxate affect TLESR-termination events. The aims of this study were to determine the pattern of terminating esophageal motor activity after TLESR in healthy subjects and factors affecting the type of terminating motor event. Fifteen healthy subjects (7 men, age 18–56) were studied. High-resolution manometry and impedance/pH monitoring were performed simultaneously in supine position for 2 h after subjects took a 1,000-kcal meal (Awake Study). This procedure was repeated during the night under polysomnographic recording for 6–8 h after consuming a 1,000-kcal meal (Sleep Study). We categorized three types of TLESR-terminating motor events, primary peristalsis (PP), full secondary contraction (FSC), which propagated the entire esophagus, and partial secondary contractions (PSC), which started distal to the upper esophageal sphincter. Overall, 289 TLESR events were found. The percentages of TLESR events terminated by PP, FSC, and PSC were 22%, 14%, and 64%, respectively. TLESR events terminated by PP were less likely to be accompanied by reflux events. TLESR events terminated by FSC were significantly more likely to have evidence for proximal esophageal reflux and esophago-pharyngeal reflux. Findings were similar in awake and sleep states. We concluded that, in healthy recumbent subjects, the most common TLESR-termination event is a secondary contraction, rather than PP. Presence and distribution of the refluxate is a major influence on the type of terminating contraction.

impedance/pH; lower esophageal sphincter; peristalsis; transient lower esophageal sphincter relaxation