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. 1998 Feb;42(2):251–257. doi: 10.1136/gut.42.2.251

Motor function of the proximal stomach and visceral perception in gastro-oesophageal reflux disease

R Penagini 1, G Hebbard 1, M Horowitz 1, J Dent 1, H Bermingham 1, K Jones 1, R Holloway 1
PMCID: PMC1727001  PMID: 9536951

Abstract

Background—The abnormally high postprandial rate of transient lower oesophageal sphincter relaxations seen in patients with reflux disease may be related to altered proximal gastric motor function. Heightened visceral sensitivity may also contribute to reporting of symptoms in these patients. 
Aims—To assess motor function of the proximal stomach and visceral perception in reflux disease with a barostat. 
Methods—Fasting and postprandial proximal gastric motility, sensation, and symptoms were measured in nine patients with reflux disease and nine healthy subjects. Gastric emptying of solids and liquids was assessed in six of the patients on a different day (and compared to historical controls). 
Results—Minimal distending pressure and gastric compliance were similar in the two groups, whereas the patients experienced fullness at lower pressures (p<0.05) and discomfort at lower balloon volumes (p<0.005) during isobaric and isovolumetric distensions respectively. Maximal gastric relaxation induced by the meal was similar in the two groups. Late after the meal, however, proximal gastric tone was lower (p<0.01) and the score for fullness higher (p<0.01) in the reflux patients, in whom the retention of both solids and liquids in the proximal stomach was greater (p<0.05). 
Conclusions—Reflux disease is associated with delayed recovery of proximal gastric tone after a meal and increased visceral sensitivity. The former may contribute to the increased prevalence of reflux during transient lower oesophageal sphincter relaxations and the delay in emptying from the proximal stomach, whereas both may contribute to symptom reporting. 



Keywords: barostat; tone; compliance; mechanics

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Figure 1 .

Figure 1

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Relation between intragastric pressure and volume during fasting isobaric (upper panel) and isovolumetric (lower panel) distension of the stomach. 


Figure 2 .

Figure 2

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Postprandial change in proximal gastric volume. Data are expressed as mean (SEM); *p<0.01 versus normal. 


Figure 3 .

Figure 3

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Scores for fullness (upper panel) and hunger (lower panel) before and after a meal. Data are expressed as mean (SEM); *p<0.01 versus normal. 


Figure 4 .

Figure 4

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Emptying of the solid and liquid component from the total stomach. Each point represents the value for a single subject. The horizontal bars indicate median values. 


Figure 5 .

Figure 5

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Emptying of the solid and liquid components of a meal from the proximal (upper panel) and distal (lower panel) stomach. Each point represents the value for a single subject. The horizontal bars indicate median values. *p<0.05 versus normal, **p<0.01 versus normal. 


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