The mechanisms associated with reflux episodes in ambulant subjects with gastro-esophageal reflux disease.
Barrett's esophagus
gastro-esophageal junction
gastro-esophageal reflux disease
hiatus hernia
high-resolution manometry
pH impedance
transient lower esophageal sphincter relaxation
Journal
Neurogastroenterology and motility
ISSN: 1365-2982
Titre abrégé: Neurogastroenterol Motil
Pays: England
ID NLM: 9432572
Informations de publication
Date de publication:
04 2021
04 2021
Historique:
revised:
29
09
2020
received:
02
05
2020
accepted:
01
10
2020
pubmed:
29
10
2020
medline:
20
11
2021
entrez:
28
10
2020
Statut:
ppublish
Résumé
The mechanisms associated with gastro-esophageal reflux (GER) episodes were studied using combined High-resolution Impedance Manometry (HRIM) and pH monitoring in ambulant subjects with different patterns of GERD. Sixteen subjects with mild-moderate esophagitis (Los Angeles (LA) grade A&B) (group A) and 11 subjects with severe esophagitis (LA grade C&D) or Barrett's esophagus (BE) were studied before and after a meal, resting, while walking, and during standardized exercise, using a HRIM and a pH probe. Post-prandial acid GER episodes were more common in group B (median 10 range (3-18) vs A (6.5 (0-18), p = 0.048). Postprandial acid clearance time was much longer in group B (median 0.71( 0.07-2.66 min) vs A (0.17 (0.04-2.44 min), p = 0.02). Transient lower esophageal sphincter relaxation (TLESR) was the most frequent mechanism associated with GER episodes in both groups. Post-prandial TLESRs with GER were more common in group B (median 17 (9-24) vs A 13.5 (7-34), p = 0.014), particularly during exercise (B 8 (6-9) vs A 6 (5-6.8), p = 0.007). Post-prandially TLESR with acid reflux increased during exercise in both groups (A rest median 2.4 (0-6.4) per hour vs exercise 4.7 (0-17.3), p = 0.005 and B 4 (0.8-9.6) vs 5.3 (2.7-13.3) per hour, p = 0.045). TLESR was the most common mechanism associated with reflux episodes in all subjects. Acid reflux episodes were more common in subjects with severe esophagitis or BE and esophageal acid clearance was much slower. Post-prandial exercise increased TLESR with acid reflux and GERD patients should be encouraged to avoid exercise immediately after a meal.
Sections du résumé
BACKGROUND
The mechanisms associated with gastro-esophageal reflux (GER) episodes were studied using combined High-resolution Impedance Manometry (HRIM) and pH monitoring in ambulant subjects with different patterns of GERD.
METHODS
Sixteen subjects with mild-moderate esophagitis (Los Angeles (LA) grade A&B) (group A) and 11 subjects with severe esophagitis (LA grade C&D) or Barrett's esophagus (BE) were studied before and after a meal, resting, while walking, and during standardized exercise, using a HRIM and a pH probe.
KEY RESULTS
Post-prandial acid GER episodes were more common in group B (median 10 range (3-18) vs A (6.5 (0-18), p = 0.048). Postprandial acid clearance time was much longer in group B (median 0.71( 0.07-2.66 min) vs A (0.17 (0.04-2.44 min), p = 0.02). Transient lower esophageal sphincter relaxation (TLESR) was the most frequent mechanism associated with GER episodes in both groups. Post-prandial TLESRs with GER were more common in group B (median 17 (9-24) vs A 13.5 (7-34), p = 0.014), particularly during exercise (B 8 (6-9) vs A 6 (5-6.8), p = 0.007). Post-prandially TLESR with acid reflux increased during exercise in both groups (A rest median 2.4 (0-6.4) per hour vs exercise 4.7 (0-17.3), p = 0.005 and B 4 (0.8-9.6) vs 5.3 (2.7-13.3) per hour, p = 0.045).
CONCLUSIONS AND INFERENCES
TLESR was the most common mechanism associated with reflux episodes in all subjects. Acid reflux episodes were more common in subjects with severe esophagitis or BE and esophageal acid clearance was much slower. Post-prandial exercise increased TLESR with acid reflux and GERD patients should be encouraged to avoid exercise immediately after a meal.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e14023Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
© 2020 John Wiley & Sons Ltd.
Références
Vakil N, Moayyedi P, Fennerty MB, Talley NJ. Limited value of alarm features in the diagnosis of upper gastrointestinal malignancy: systematic review and meta-analysis. Gastroenterology. 2006;131(2):390-401; quiz 659-360.
Fullard M, Kang JY, Neild P, Poullis A, Maxwell JD. Systematic review: does gastro-oesophageal reflux disease progress? Aliment Pharmacol Ther. 2006;24(1):33-45.
Fass R, Ofman JJ. Gastroesophageal reflux disease-should we adopt a new conceptual framework? Am J Gastroenterol. 2002;97(8):1901-1909.
Dent J, Holloway RH, Toouli J, Dodds WJ. Mechanisms of lower oesophageal sphincter incompetence in patients with symptomatic gastrooesophageal reflux. Gut. 1988;29(8):1020-1028.
Mittal RK, Holloway RH, Penagini R, Blackshaw LA, Dent J. Transient lower esophageal sphincter relaxation. Gastroenterology. 1995;109(2):601-610.
Schoeman MN, Tippett MD, Akkermans LM, Dent J, Holloway RH. Mechanisms of gastroesophageal reflux in ambulant healthy human subjects. Gastroenterology. 1995;108(1):83-91.
Penagini R, Schoeman MN, Dent J, Tippett MD, Holloway RH. Motor events underlying gastro-oesophageal reflux in ambulant patients with reflux oesophagitis. Neurogastroenterol Motil. 1996;8(2):131-141.
van Herwaarden MA, Samsom M, Smout AJ. Excess gastroesophageal reflux in patients with hiatus hernia is caused by mechanisms other than transient LES relaxations. Gastroenterology. 2000;119(6):1439-1446.
Sifrim D, Holloway R, Silny J, Tack J, Lerut A, Janssens J. Composition of the postprandial refluxate in patients with gastroesophageal reflux disease. Am J gastroenterol. 2001;96(3):647-655.
Trudgill NJ, Riley SA. Transient lower esophageal sphincter relaxations are no more frequent in patients with gastroesophageal reflux disease than in asymptomatic volunteers. Am J Gastroenterol. 2001;96(9):2569-2574.
Sloan S, Rademaker AW, Kahrilas PJ. Determinants of gastroesophageal junction incompetence: hiatal hernia, lower esophageal sphincter, or both? Ann Intern Med. 1992;117(12):977-982.
Bredenoord AJ, Weusten BL, Timmer R, Smout AJ. Intermittent spatial separation of diaphragm and lower esophageal sphincter favors acidic and weakly acidic reflux. Gastroenterology. 2006;130(2):334-340.
Sifrim D, Silny J, Holloway RH, Janssens JJ. Patterns of gas and liquid reflux during transient lower oesophageal sphincter relaxation: a study using intraluminal electrical impedance. Gut. 1999;44(1):47-54.
Clouse RE, Staiano A. Topography of the esophageal peristaltic pressure wave. Am J Physiol. 1991;261(4 Pt 1):G677-G684.
Clouse RE, Staiano A, Alrakawi A, Haroian L. Application of topographical methods to clinical esophageal manometry. Am J Gastroenterol. 2000;95(10):2720-2730.
Lundell LR, Dent J, Bennett JR, et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut. 1999;45(2):172-180.
Santonicola A, Angrisani L, Vitiello A, et al. Hiatal hernia diagnosis prospectively assessed in obese patients before bariatric surgery: accuracy of high-resolution manometry taking intraoperative diagnosis as reference standard. Surg Endosc. 2020;34(3):1150-1156.
Iovino P, Mohammed I, Anggiansah A, et al. A study of pathophysiological factors associated with gastro-esophageal reflux disease in twins discordant for gastro-esophageal reflux symptoms. Neurogastroenterol Motil. 2013;25(8):650-656.
Beaumont H, Bennink RJ, de Jong J, Boeckxstaens GE. The position of the acid pocket as a major risk factor for acidic reflux in healthy subjects and patients with GORD. Gut. 2010;59(4):441-451.
Sifrim D, Castell D, Dent J, Kahrilas PJ. Gastro-oesophageal reflux monitoring: review and consensus report on detection and definitions of acid, non-acid, and gas reflux. Gut. 2004;53(7):1024-1031.
Holloway RH, Penagini R, Ireland AC. Criteria for objective definition of transient lower esophageal sphincter relaxation. Am J Physiol. 1995;268(1 Pt 1):G128-133.
Holloway RH, Boeckxstaens GE, Penagini R, Sifrim D, Smout AJ. Objective definition and detection of transient lower esophageal sphincter relaxation revisited: is there room for improvement? Neurogastroenterol Motil. 2012;24(1):54-60.
Roman S, Holloway R, Keller J, et al. Validation of criteria for the definition of transient lower esophageal sphincter relaxations using high-resolution manometry. Neurogastroenterol Motil. 2017;29(2):e12920.
Bredenoord AJ, Weusten BL, Sifrim D, Timmer R, Smout AJ. Aerophagia, gastric, and supragastric belching: a study using intraluminal electrical impedance monitoring. Gut. 2004;53(11):1561-1565.
Pandolfino JE, Kim H, Ghosh SK, Clarke JO, Zhang Q, Kahrilas PJ. High-resolution manometry of the EGJ: an analysis of crural diaphragm function in GERD. Am J Gastroenterol. 2007;102(5):1056-1063.
Thas O, Neve JD, Clement L, Ottoy J-P. Probabilistic index models. J R Stat Soc: Ser B (Stat Methodol). 2012;74(4):623-671.
He S, Jell A, Hüser N, Kohn N, Feussner H. 24-hour monitoring of transient lower esophageal sphincter relaxation events by long-term high-resolution impedance manometry in normal volunteers: The "mirror phenomenon". Neurogastroenterol Motil. 2019;31(3):e13530.
Helm JF, Dodds WJ, Pelc LR, Palmer DW, Hogan WJ, Teeter BC. Effect of esophageal emptying and saliva on clearance of acid from the esophagus. N Engl J Med. 1984;310(5):284-288.
Ribolsi M, Holloway RH, Emerenziani S, Balestrieri P, Cicala M. Impedance-high resolution manometry analysis of patients with nonerosive reflux disease. Clin Gastroenterol Hepatol. 2014;12(1):52-57.
Jones MP, Sloan SS, Jovanovic B, Kahrilas PJ. Impaired egress rather than increased access: an important independent predictor of erosive oesophagitis. Neurogastroenterol Motil. 2002;14(6):625-631.
Rohof WO, Bisschops R, Tack J, Boeckxstaens GE. Postoperative problems 2011: fundoplication and obesity surgery. Gastroenterol Clin North Am. 2011;40(4):809-821.
Roman S, Zerbib F, Belhocine K, des Varannes SB, Mion F. High resolution manometry to detect transient lower oesophageal sphincter relaxations: diagnostic accuracy compared with perfused-sleeve manometry, and the definition of new detection criteria. Aliment Pharmacol Ther. 2011;34(3):384-393.
Herregods TV, van Hoeij FB, Oors JM, Bredenoord AJ, Smout AJ. Effect of running on gastroesophageal reflux and reflux mechanisms. Am J Gastroenterol. 2016;111(7):940-946.
Clark CS, Kraus BB, Sinclair J, Castell DO. Gastroesophageal reflux induced by exercise in healthy volunteers. Jama. 1989;261(24):3599-3601.
Collings KL, Pierce Pratt F, Rodriguez-Stanley S, Bemben M, Miner PB. Esophageal reflux in conditioned runners, cyclists, and weightlifters. Med Sci Sports Exerc. 2003;35(5):730-735.