Effect of atropine on gastro-oesophageal reflux and transient lower oesophageal sphincter relaxations in patients with gastro-oesophageal reflux disease
I Lidums
a Department of
Gastrointestinal Medicine, Royal Adelaide Hospital, Adelaide, South
Australia, b Gastroenterology Division, University of
Virginia Health Sciences Center, Charlottesville, VA, USA
Correspondence to: Dr R Holloway, Department of Gastrointestinal Medicine, Royal
Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia. Accepted for publication 4 February 1998 Background Keywords:
gastro-oesophageal reflux;
lower oesophageal
sphincter;
manometry;
diaphragm;
atropine;
pharmacology
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.
MethodsOesophageal
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.
ResultsAtropine
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.
ConclusionsAtropine
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.
(GUT 1998;43:12-16)
© 1998 by Gut
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