Abstract
The effect of a meal on the rate of transient lower esophageal sphinter (LES) relaxations and patterns of gastroesophageal reflux was investigated in 49 patients referred for evaluation of gastroesophageal reflux. Esophageal motility and pH were recorded concurrently before and after a standard meal. In the patients with symptomatic reflux, the meal induced a four-to sevenfold increase in the gastroesophageal reflux through two mechanisms: a four-to fivefold increase in the rate of transient LES relaxations and an increase in the proportion of transient LES relaxations accompanied by reflux from 47% to 68^. Overall the rate of reflux episodes that occurred by mechanisms other than transient LES relaxation did not increase significantly. An exception to these findings were those in six patients with chronically absent basal LES pressure in whom transient LES relaxations could not be scored. In these patients, reflux increased postprandially through mechanisms other than transient LES relaxation. These findings confirm the pivotal importance of transient LES relaxations in the pathogenesis of gastroesophageal reflux.
Similar content being viewed by others
References
Dent J, Dodds WJ, Friedman RH, Sekiguchi T, Hogan WJ, Arndorfer RC, Petrie DJ: Mechanisms of gastroesophageal reflux in recumbent asymptomatic human subjects. J Clin Invest 65:256–267, 1980
Dodds WJ, Dent J, Hogan WJ, Helm J, Hauser R, Patel G, Egide M: Mechanisms of gastroesophageal reflux in patients with reflux esophagitis. N Engl J Med 307:1547–1552, 1982
Fink SM, McCallum RW: The role of prolonged esophageal pH monitoring in the diagnosis of gastroesophageal reflux. JAMA 252:1160–1169, 1984
Dent J, Holloway RH, Toouli J, Dodds WJ: Mechanisms of lower oesophageal sphincter incompetence in patients with symptomatic gastroesophageal reflux. Gut 29:1020–1028, 1988
Mittal RK, McCallum RW: Characteristics of transient lower esophageal sphincter relaxations in humans. Am J Physiol 252:G636-G641, 1987
Mittal RK, McCallum RW: Characteristics and frequency of transient relaxations of the lower esophageal sphincter in patients with reflux esophagitis. Gastroenterology 95:593–599, 1988
Orr WC, Robinson MG, Johnson LF: Acid clearance during sleep in the pathogenesis of reflux esophagitis. Dig Dis Sci 26:423–427, 1981
Freiden N, Ren J, Sluss J, McCallum RW: The effect of a large meal and graded intragastric distension on transient LES relaxation (TLESR) frequency in normals. Gastroenterology 95:866, 1988 (abstract)
Freiden N, Ren J, Sluss J, McCallum RW: The effect of a large meal on the frequency and quality of transient LES relaxations (TLESR). Gastrointest Motil 1:62, 1989 (abstract)
Holloway RH, Hongo M, Berger K, McCallum RW: Gastric distension: Mechanisms for post-prandial gastroesophageal reflux. Gastroenterology 89:779–784, 1985
Patrikios J, Martin CJ, Dent J: Relationship of transient lower esophageal sphincter relaxation to gastroesophageal reflux and belching in dogs. Gastroenterology 90:545–551, 1986
Andrews PLR, Grundy D, Scatchard T: Vagal afferent discharge from mechanoreceptors in different regions of the ferret stomach. J Physiol (London) 298:513–524, 1980
Wyman JB, Dent J, Heddle R, Dodds WJ, Toouli J, Downton J: Control of belching by the lower oesophageal sphincter. Gut 31:639–646, 1990
Wyman JB, Dent J, Dodds WJ, Skerven M: Gastric distension, belching and triggering of transient lower oesophageal sphincter relaxation in reflux oesophagitis. Aust NZ J Med 18(suppl):191, 1988 (abstract)
Mittal RK, Fisher M, Sluss J: Electrical and mechanical inhibition of the crural diaphragm during transient relaxation of the lower esophageal sphincter. Gastrointest Motil 1:46, 1989 (abstract)
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Holloway, R.H., Kocyan, P. & Dent, J. Provocation of transient lower esophageal sphincter relaxations by meals in patients with symptomatic gastroesophageal reflux. Digest Dis Sci 36, 1034–1039 (1991). https://doi.org/10.1007/BF01297443
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01297443