Gastric emptying: a contributory factor in gastro-oesophageal reflux activity?
- aPsychophysiology Unit at the Department of Surgery, University of Vienna, Vienna, Austria, bInstitute of Biomedical Engineering and Physics, University of Vienna, Vienna, Austria, cInstitute of Medical Statistics, University of Vienna, Vienna, Austria, dDepartment of Nuclear Medicine, University of Vienna, Vienna, Austria, eLudwig Boltzmann Institute of Nuclear Medicine, Vienna, Austria
- Dr G Stacher, Psychophysiologisches Laboratorium, Waehringer Guertel 18–20, A-1090 Wien, Austria. georg.stacher{at}akh-wien.ac.at
- Accepted 9 May 2000
Abstract
AIMS To evaluate the impact of total and proximal stomach emptying on 24 hour and postprandial reflux as well as the number of reflux episodes per hour in relation to the impact of lower oesophageal sphincter (LOS) pressure, and oesophageal contractile and clearance function.
METHODS Seventy one outpatients (37 female, 34 male; age 23–82 years) with symptoms suggestive of both delayed gastric emptying and reflux referred for further investigations participated in the study. Gastric emptying of a semisolid 1168 kJ meal and oesophageal clearance of a water bolus (supine) were recorded scintigraphically, reflux by 24 hour pH monitoring, and oesophageal motility manometrically.
RESULTS Slow proximal but not slow distal or total stomach emptying correlated with increased 24 hour and postprandial acid exposure and increased number of reflux episodes/hour. No relationship was found between total or proximal emptying and LOS resting pressure, oesophageal contraction amplitude, percentage of failed contractions, or clearance. Multiple linear regression analyses showed that slow proximal emptying and low LOS pressure contributed significantly to both 24 hour (p=0.0007 and p=0.0001) and two hour postprandial acid exposure (p=0.007 and p=0.0001). In contrast, the rate of total emptying contributed to neither 24 hour nor postprandial acid exposure.
CONCLUSION Our data suggest that in contrast with total stomach emptying, the rate of proximal stomach emptying contributes to the extent of 24 hour as well as postprandial acid exposure and the number of reflux episodes/hour.
- gastro-oesophageal reflux
- gastric emptying
- proximal stomach
- lower oesophageal sphincter
- oesophageal motor activity
- oesophageal clearance
Footnotes
- Abbreviations used in this paper:
- AUCtot
- AUCprox, AUCdist, area under emptying curve of total, proximal, and distal stomach
- BMI
- body mass index
- LOS
- lower oesophageal sphincter
