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. 1999 Mar;44(3):313–316. doi: 10.1136/gut.44.3.313

Preservation of postural control of transient lower oesophageal sphincter relaxations in patients with reflux oesophagitis

A Ireland 1, J Dent 1, R Holloway 1
PMCID: PMC1727412  PMID: 10026313

Abstract

INTRODUCTION—In normal subjects, transient lower oesophageal sphincter relaxations (TLOSRs) and gas reflux during belching are suppressed in the supine position. Supine reflux, however, is a feature of reflux disease. 
AIMS—To investigate whether postural suppression of TLOSRs and gas reflux is impaired in patients with reflux disease. 
PATIENTS—Ten patients with erosive oesophagitis. 
METHODS—Oesophageal manometry was performed during gastric distension with 750 ml carbon dioxide. Measurements were made for 10 minutes before and after distension in both sitting and supine positions. 
RESULTS—In the sitting position gastric distension substantially increased the rate of gas reflux (median (interquartile range)), as evidenced by increases in oesophageal common cavities from 1 (0-1)/10 min to 7 (5-10)/10 min and TLOSRs from 1 (1-1.5)/10 min to 6 (2.5-8)/10 min. However, this effect was suppressed in the supine position in all but one patient (TLOSRs 0 (0)/10 min to 1 (0-4.5)/10 min, common cavities 0 (0)/10 min to 0.5 (0-2)/10 min). 
CONCLUSIONS—Postural suppression of TLOSRs and gas reflux is generally preserved in reflux disease. 



Keywords: gastro-oesophageal reflux; lower oesophageal sphincter; posture; oesophageal manometry

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Figure 1 .

Figure 1

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Schematic representation of the protocol for posture and gas loading followed in the study. 


Figure 2 .

Figure 2

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Rate of oesophageal common cavities before and after gastric distension with gas. Each dot repesents data for an individual patient. The horizontal bars indicate median values. *p<0.05, **p<0.01. 


Figure 3 .

Figure 3

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Effect of posture on patterns of lower oesophageal sphincter (LOS) and oesophageal motility associated with oesophageal common cavities. p<0.01 supine v sitting. TLOSR, transient LOS relaxation; LOSP, LOS pressure; swallow induced, swallow induced LOS relaxation. 


Figure 5 .

Figure 5

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Effect of posture and gastric disension on basal lower oesophageal sphincter (LOS) pressure. The bars represent mean (SEM). 


Figure 4 .

Figure 4

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Rate of transient lower oesophageal sphincter relaxations (TLOSRs) before and after gastric distension with gas. Each dot repesents data for an individual patient. The horizontal bars indicate median values. *p<0.05, †p<0.03. Basal LOS pressure was similar in the sitting and supine positions and was not affected by gastric distension in either position (fig 5). 


Selected References

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

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