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. 1998 Jul;43(1):12–16. doi: 10.1136/gut.43.1.12

Effect of atropine on gastro-oesophageal reflux and transient lower oesophageal sphincter relaxations in patients with gastro-oesophageal reflux disease

I Lidums 1, H Checklin 1, R Mittal 1, R Holloway 1
PMCID: PMC1727184  PMID: 9771399

Abstract

Background—Atropine reduces the rate of reflux episodes in normal subjects by inhibition of transient lower oesophageal sphincter (LOS) relaxations. The aim of this study was to investigate the effect of atropine on the rate and mechanisms of reflux in patients with reflux disease. 
Methods—Oesophageal motility and pH were recorded for one hour after a meal in 15 patients with reflux disease. On separate days, atropine (15 µg/kg bolus intravenously, 4 µg/kg/h infusion) or saline were given and maintained for the recording period. 
Results—Atropine significantly reduced basal LOS pressure from 7.1 (2.2) to 2.9 (1.3) mm Hg (mean (SEM)). Atropine also reduced the rate of reflux episodes from 5.0 (2.0-8.75) to 1.0 (0-6.25) per hour (median (interquartile range)) largely because of a decrease in the rate of transient LOS relaxations from 2.0 (0-4.75) to 0 (0-0) per hour and abolition of reflux during swallow induced LOS relaxation. There was no change in the rate of reflux episodes because of absent basal LOS pressure. 
Conclusions—Atropine inhibits reflux in patients with reflux disease largely by inhibition of transient LOS relaxations and swallow induced LOS relaxation. These findings suggest that pharmacological control of reflux through control of transient LOS relaxations is possible in patients with reflux disease. 



Keywords: gastro-oesophageal reflux; lower oesophageal sphincter; manometry; diaphragm; atropine; pharmacology

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Figure 1 .

Figure 1

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Effect of atropine on lower basal oesophageal sphincter (LOS) pressure. Data have been grouped into intervals of pressure and are expressed as a percentage of the total recording time. Atropine significantly increased the proportion of time that LOS pressure was 2 mm Hg or less. *p<0.05 v control (saline infusion). Open columns, saline; closed columns, atropine. 


Figure 2 .

Figure 2

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Effect of atropine on the number of reflux episodes. Data are depicted as median (interquartile range). *p<0.05 v control (saline infusion). 


Figure 3 .

Figure 3

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Mechanism of reflux during saline and atropine infusion. The data for each group have been pooled and the numbers in parentheses indicate the percentage of reflux episodes. LOSP, lower oesophageal sphincter pressure; TLOSR, transient LOS relaxation. 


Figure 4 .

Figure 4

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Effect of atropine on the mechanism of reflux. Each point represents the proportion of reflux episodes in an individual patient that is attributable to a particular mechanism. LOSR, lower oesophageal sphincter relaxation; LOSP, lower oesophageal sphincter pressure. Open circles, saline; closed circles, atropine. 


Figure 5 .

Figure 5

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Effect of atropine on the number of transient lower oesophageal sphincter relaxations (TLOSRs). The data are depicted as median and interquartile range. *p<0.01 v control (saline infusion). 


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