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. 1994 Nov;35(11):1536–1542. doi: 10.1136/gut.35.11.1536

Primary peristalsis is the major acid clearance mechanism in reflux patients.

A Anggiansah 1, G Taylor 1, N Bright 1, J Wang 1, W A Owen 1, T Rokkas 1, A R Jones 1, W J Owen 1
PMCID: PMC1375607  PMID: 7828968

Abstract

This study examined the clearance of gastric acid from the oesophagus in ambulant patients with gastro-oesophageal reflux. Eighteen patients with proved reflux disease were studied, nine with (group 1) and nine without (group 2) endoscopic oesophagitis. Oesophageal pressure and pH were recorded over 24 hours. Pressures were measured by a probe with five sensors: a 5 cm long sensor in the lower oesophageal sphincter, three sensors in the body of the oesophagus, and one at the pharynx to detect swallowing. Oesophageal pH was monitored 5 cm above the lower oesophageal sphincter. Manometric activities were classified as either peristaltic or ineffective. The latter included simultaneous, non-transmitted, and low amplitude peristaltic contractions. A reflux episode was defined as starting when pH fell to less than 4 and ending when the pH rose to 5. When the rise to pH 5 took place in three or more discrete steps after motor responses to gastro-oesophageal reflux, the pH steps were labelled as initial change (I), middle changes (M), and last change (L). A total of 595 episodes of gastro-oesophageal reflux and 1626 associated motor events were analysed. Of these, 1331 (81.9%) were classed as primary peristaltic activity, 174 (10.7%) as primary ineffective activity, 46 (2.8%) as secondary peristaltic activity, and 75 (4.6%) as secondary ineffective activity. There were no significant differences in initial change (p > 0.05), middle changes (p > 0.05), and last change (p > 0.05) between group 1 and group 2. In all patients, the successive changes of pH in response to motor activity were significantly different (p = 0.0001) between initial, middle, and last changes. Last change was significantly higher when compared with initial (p=0.001) and middle changes (p<0.001). Primary oesophageal peristalsis was the most frequent motor response to gastro-oesophageal reflux. The last motor activity during reflux showed the greatest change in pH.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Barham C. P., Gotley D. C., Miller R., Mills A., Alderson D. Pressure events surrounding oesophageal acid reflux episodes and acid clearance in ambulant healthy volunteers. Gut. 1993 Apr;34(4):444–449. doi: 10.1136/gut.34.4.444. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Demeester T. R., Johnson L. F., Joseph G. J., Toscano M. S., Hall A. W., Skinner D. B. Patterns of gastroesophageal reflux in health and disease. Ann Surg. 1976 Oct;184(4):459–470. doi: 10.1097/00000658-197610000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Dent J. A new technique for continuous sphincter pressure measurement. Gastroenterology. 1976 Aug;71(2):263–267. [PubMed] [Google Scholar]
  4. Dent J., Holloway R. H., Toouli J., Dodds W. J. Mechanisms of lower oesophageal sphincter incompetence in patients with symptomatic gastrooesophageal reflux. Gut. 1988 Aug;29(8):1020–1028. doi: 10.1136/gut.29.8.1020. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Dodds W. J., Hogan W. J., Helm J. F., Dent J. Pathogenesis of reflux esophagitis. Gastroenterology. 1981 Aug;81(2):376–394. [PubMed] [Google Scholar]
  6. Emde C., Garner A., Blum A. L. Technical aspects of intraluminal pH-metry in man: current status and recommendations. Gut. 1987 Sep;28(9):1177–1188. doi: 10.1136/gut.28.9.1177. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Gotley D. C., Barham C. P., Miller R., Arnold R., Alderson D. The sphinctometer: a new device for measurement of lower oesophageal sphincter function. Br J Surg. 1991 Aug;78(8):933–935. doi: 10.1002/bjs.1800780812. [DOI] [PubMed] [Google Scholar]
  8. Helm J. F., Dodds W. J., Pelc L. R., Palmer D. W., Hogan W. J., Teeter B. C. Effect of esophageal emptying and saliva on clearance of acid from the esophagus. N Engl J Med. 1984 Feb 2;310(5):284–288. doi: 10.1056/NEJM198402023100503. [DOI] [PubMed] [Google Scholar]
  9. Helm J. F., Dodds W. J., Riedel D. R., Teeter B. C., Hogan W. J., Arndorfer R. C. Determinants of esophageal acid clearance in normal subjects. Gastroenterology. 1983 Sep;85(3):607–612. [PubMed] [Google Scholar]
  10. Hewson E. G., Ott D. J., Dalton C. B., Chen Y. M., Wu W. C., Richter J. E. Manometry and radiology. Complementary studies in the assessment of esophageal motility disorders. Gastroenterology. 1990 Mar;98(3):626–632. [PubMed] [Google Scholar]
  11. Johnson L. F., Demeester T. R. Twenty-four-hour pH monitoring of the distal esophagus. A quantitative measure of gastroesophageal reflux. Am J Gastroenterol. 1974 Oct;62(4):325–332. [PubMed] [Google Scholar]
  12. Kahrilas P. J., Dodds W. J., Hogan W. J. Effect of peristaltic dysfunction on esophageal volume clearance. Gastroenterology. 1988 Jan;94(1):73–80. doi: 10.1016/0016-5085(88)90612-9. [DOI] [PubMed] [Google Scholar]
  13. Kahrilas P. J., Dodds W. J., Hogan W. J., Kern M., Arndorfer R. C., Reece A. Esophageal peristaltic dysfunction in peptic esophagitis. Gastroenterology. 1986 Oct;91(4):897–904. doi: 10.1016/0016-5085(86)90692-x. [DOI] [PubMed] [Google Scholar]
  14. Kahrilas P. J. Esophageal motor activity and acid clearance. Gastroenterol Clin North Am. 1990 Sep;19(3):537–550. [PubMed] [Google Scholar]
  16. Skinner D. B., Booth D. J. Assessment of distal esophageal function in patients with hiatal hernia and-or gastroesophageal reflux. Ann Surg. 1970 Oct;172(4):627–637. doi: 10.1097/00000658-197010000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Sonnenberg A., Steinkamp U., Weise A., Berges W., Wienbeck M., Rohner H. G., Peter P. Salivary secretion in reflux esophagitis. Gastroenterology. 1982 Oct;83(4):889–895. [PubMed] [Google Scholar]
  18. Timmer R., Breumelhof R., Nadorp J. H., Smout A. J. Oesophageal motor response to reflux is not impaired in reflux oesophagitis. Gut. 1993 Mar;34(3):317–320. doi: 10.1136/gut.34.3.317. [DOI] [PMC free article] [PubMed] [Google Scholar]

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