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Upper esophageal sphincter (UES) pressure changes during transient lower esophageal sphincter relaxation (TLESR). Most patients with gastroesophageal reflux show an increase in UES pressure during TLESR. However, many controls exhibit no UES pressure changes during TLESR. GERD, gastroesophageal reflux disease.
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Transient lower esophageal sphincter relaxation (TLESR) is the main mechanism of gastroesophageal reflux disease (GERD). The aim of this study was to investigate the characteristics of transient lower esophageal sphincter movement in patients with or without gastroesophageal reflux by high-resolution manometry (HRM).
From June 2010 to July 2010, we...
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Context 1
... with GERD showed primarily increasing UES pressure during TLESR. Twenty-five TLESR (75.8%) events revealed increasing UES pressure in the GERD group. However, only six were associated with increasing UES pressure in the control group. The frequency of increasing UES pressure differed between the groups (P = 0.001) (Fig. 2). The percen- tages of UES relaxation were 21.2% in the GERD group and 73.5% in the control group (P = ...Similar publications
Background
Upper esophageal sphincter (UES) metrics on high‐resolution manometry (HRM), particularly nadir UES residual pressure (UES‐RP), are abnormal in achalasia and may help characterize the underlying mechanism or predict management outcome in esophagogastric junction outflow obstruction (EGJOO).
Methods
A database of consecutive patients und...
Aims: We tested the hypothesis that the sensory-motor characteristics of aerodigestive reflexes are dependent on stimulus type and volumes, sleep or awake states and maturation. Methods: Thirteen neonates were studied at 33.6 ± 0.5 (time-1) and 37.3 ± 0.5 weeks (time-2) postmenstrual age using multi-modal provocative esophageal manometry concurrent...
Even though the pathogenesis of idiopathic pulmonary fibrosis (IPF) is unknown, there is mounting evidence that abnormal reflux (GERD) and aspiration of gastric contents may play a role in the pathogenesis of this disease.
The aims of this study were to determine in patients with GERD and IPF: (a) the clinical presentation, (b) the esophageal funct...
Peroral endoscopic myotomy (POEM) as a new approach to achalasia attracts broad attention. The primary objective of this study was to evaluate the results with esophageal motility after POEM through the first large sample clinical research.
We have a self-control research with all patients (205 in total) who underwent POEM from 2010 to 2014 at our...
Background and Aim
We aimed to evaluate the application of Peptest, a novel technique to detect pepsin in the saliva, and identify its threshold level for the diagnosis of gastroesophageal reflux disease (GERD) with extraesophageal symptoms.
Methods
A cross‐sectional study was conducted in two groups: patients with extraesophageal GERD symptoms (s...
Citations
... Although the variability in frequency of TLESRs varies in different studies from 0 to 12 TLESRs/hour. [27,28] Both studies included both complete and incomplete TLESRs. To our knowledge this is the first study that analyzed the number of TLESRs after ARMS. ...
... -ASA classification of III or higher. Health-related QoL GERD 28 (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32) Brief dysphagia questionnaire (BEDQ) 7 (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14) Displayed as n(%), mean ± SD or median with IQR. HRM; high resolution manometry ...
Previous studies suggest that anti-reflux mucosectomy (ARMS) is effective in reducing reflux symptoms and total acid exposure, although the mechanism is unknown. Our objective was to investigate the effect of ARMS on reflux parameters and mechanism of action. Methods: Gastroesophageal reflux (GERD) patients with insufficient symptom control despite twice daily proton pump inhibitor (PPI) underwent a piecemeal multiband mucosectomy of 50% of the circumference of the esophago-gastric-junction (EGJ), extending 2cm into the cardia. The primary endpoint was the total number of reflux episodes during 24-h pH-impedance studies. Results: 11 patients were treated (8 men, age 37 (32-57) years), one patient is lost to follow-up after treatment. ARMS reduced the total number of reflux episodes from 74 (50-82) to 37 (28-66) p=0.008) and total acid exposure from 8.7% (6.4-12.7) to 5.3% (3.5-6.7) (p=0.008). Treatment reduced the number of transient lower esophageal sphincter relaxations (TLESRs) (from 4 (1-8) to 2 (1-4), p=0.027) during a 90-minute postprandial period. Reflux symptoms were reduced substantially (from 3.6 (3.6-3.9) to 1.6 (0.7-2.7), p=0.007). Treatment did not increase dysphagia (Brief Esophageal Dysphagia Questionnaire)of 8.2 (±7.3) to 8.5 (±6.5) (p=0.879). Impedance planimetry showed no changes in EGJ distensibility after treatment (4.4 (±2.1) mm2/mmHg to 4.3 (±2.2) mm2/mmHg), p=0.952). One delayed post-procedural bleeding (10%, (1/10)) occurred requiring repeat endoscopy, no strictures developed. Conclusion: ARMS is an effective treatment option in PPI refractory GERD patients reducing acid exposure, reflux episodes and symptoms. While its working mechanism could not be explained by a difference in distensibility, a reduction in TLSERs might play a role.
... Decrease in UES pressure during transient lower esophageal sphincter relaxation was observed in 21.2% of GERD patients and in 73.5% of controls. 29 Electromyographic analysis of the cricopharyngeal muscle in GERD patients did not show differences as compared with findings in healthy volunteers. 30 Also, a study assessing esophageal striated muscle contractions by manometry did not show different results between GERD patients with and without esophagitis. ...
Introduction The upper esophageal sphincter (UES) is a muscular structure located at the transition from the pharynx to the esophagus, with the cricopharyngeal muscle as the most important component. During gastroesophageal reflux, the pressure in the UES elevates, which is apparently a protective mechanism to prevent esophagopharyngeal reflux and airway aspiration. In gastroesophageal reflux disease (GERD), there may be functional changes in the UES.
Objective The objective of the present review was to determine UES functional changes in GERD.
Data Synthesis In healthy individuals, gastroesophageal reflux causes an increase in the UES pressure. This response of the sphincter is at least partially impaired in patients with GERD. In the disease, the UES has a reduced length and decreased resting pressure. However, other publications found that in chronic gastroesophageal reflux the basal sphincter pressure increase, differences which may be consequent to the measurement method or to disease severity. The UES opening during swallowing has a smaller diameter, and the bolus transit time through the sphincter is longer.
Conclusion The UES of patients with GERD does not open as expected and the bolus flow through the sphincter is longer. This behavior may be associated with dysphagia, a frequent complaint in patients with GERD.
... One of the most widely postulated mechanisms for the development of reflux symptoms is excess transient lower esophageal sphincter relaxation (TLESR) episodes. 30 These episodes are physiologic processes that allow for venting of gastric gas and act as protection against the accumulation of excess gas in the stomach. 30 TLESRs are vasovagally induced reflexes that are triggered by gastric distention and work via several neurotransmitters and receptors, including the GABA B receptor. ...
... 30 These episodes are physiologic processes that allow for venting of gastric gas and act as protection against the accumulation of excess gas in the stomach. 30 TLESRs are vasovagally induced reflexes that are triggered by gastric distention and work via several neurotransmitters and receptors, including the GABA B receptor. 31 Through its GABA B receptor activity, baclofen inhibits TLESRs, and has been shown to significantly inhibit gastroesophageal reflux disease (GERD) episodes in both healthy volunteers and in patients with reflux disease. ...
Baclofen is an effective therapeutic for the treatment of spasticity related to multiple sclerosis, spinal cord injuries, and other spinal cord pathologies. It has been increasingly used off-label for the management of several disorders, including musculoskeletal pain, gastroesophageal reflux disease, and alcohol use disorder. Baclofen therapy is associated with potential complications, including life-threatening toxicity and withdrawal syndrome. These disorders require prompt recognition and a high index of suspicion. While these complications can develop following administration of either oral or intrathecal baclofen, the risk is greater with the intrathecal route. The management of baclofen toxicity is largely supportive while baclofen withdrawal syndrome is most effectively treated with re-initiation or supplementation of baclofen dosing. Administration of other pharmacologic adjuncts may be required to effectively treat associated withdrawal symptoms. This narrative review provides an overview of the historical and emerging uses of baclofen, offers practical dosing recommendations for both oral and intrathecal routes of administration, and reviews the diagnosis and management of both baclofen toxicity and withdrawal.
... A similar behavior occurs during transient lower esophageal sphincter relaxation (tLESR). This spontaneous relaxation of the LES periodically allows air trapped in the stomach to escape [43]. Following this type of opening in the model presented here, the lighter fluid is then able to increase the area of the sphincter and enter the esophageal lumen as shown in Fig. 7f. ...
Over the past few decades, in silico modeling of organ systems has significantly furthered our understanding of their physiology and biomechanical function. In this work, we present a detailed numerical model of the upper gastrointestinal (GI) tract that not only accounts for the fiber architecture of the muscle walls, but also the multiphasic components they help transport during normal digestive function. Construction details for 3D models of representative stomach geometry are presented along with a simple strategy for assigning circular and longitudinal muscle fiber orientations for each layer. Based on our previous work that created a fully resolved model of esophageal peristalsis, we extend the same principles to simulate gastric peristalsis by systematically activating muscle fibers embedded in the stomach. Following this, for the first time, we simulate gravity driven bolus emptying into the stomach due to density differences between ingested contents and fluid contents of the stomach. This detailed computational model of the upper gastrointestinal tract provides a foundation on which future models can be based that seek to investigate the biomechanics of acid reflux and probe various strategies for gastric bypass surgeries to address the growing problem of adult obesity.
... They found that patients with GERD were more likely to demonstrate UES contraction during tLOSRs than controls, who more frequently displayed UES relaxation. This phenomenon is hypothesized to be due to the more acidic refluxate in patients with GERD (23). ...
... Intermittent dysphagia is independently associated with GERD (8), and 31.6% and 18% of patients with GERD have frequent and infrequent dysphagia, respectively (7). Moreover, [37][38][39][40][41][42][43][44][45][46].8% of patients with esophagitis reported dysphagia in previous studies (9,10). ...
... Patients with GERD have longer UES opening during deglutition, which means a longer time for the bolus to pass through the sphincter (37,38). Other UES changes have been described, such as short and hypotonic sphincter (39) (40). Reflux events cause an intraesophageal pressure increase, which evokes UES contractile response (41). ...
Objective:
Heartburn and regurgitation are the most common gastroesophageal reflux symptoms, and dysphagia could be a possible symptom. This investigation aimed to evaluate the prevalence of non-obstructive dysphagia in patients with heartburn and regurgitation.
Methods:
A total of 147 patients (age, 20-70 years; women, 72%) complaining of heartburn and regurgitation, without esophageal stricture, previous esophageal surgery, or other diseases, were evaluated. Twenty-seven patients had esophagitis. The Eating Assessment Tool (EAT-10) was employed to screen for dysphagia; EAT-10 is composed of 10 items, and the patients rate each item from 0 to 4 (0, no problems; 4, most severe symptom). Results of the 147 patients were compared with those of 417 healthy volunteers (women, 62%; control group) aged 20-68 years.
Results:
In the control group, only two (0.5%) had an EAT-10 score ≥5, which was chosen as the threshold to define dysphagia. EAT-10 scores ≥5 were found in 71 (48.3%) patients and in 55% of the patients with esophagitis and 47% of the patients without esophagitis. This finding indicates a relatively higher prevalence of perceived dysphagia in patients with heartburn and regurgitation and in patients with esophagitis. We also found a positive correlation between EAT-10 scores and the severity of gastroesophageal reflux symptoms based on the Velanovich scale.
Conclusion:
In patients with heartburn and regurgitation symptoms, the prevalence of dysphagia was at least 48%, and has a positive correlation with the overall symptoms of gastroesophageal reflux.
... Also, in cases of incomplete TLESR, LES elevation is seen with HRM manometry, and ultrasonography shows esophageal muscle thickening 2 cm above the LES, indicating contraction of the esophageal longitudinal muscle, which may be the main cause of TLESR. 11 Hypotensive lower esophageal sphincter, crural diaphragmatic dysfunction, or increased esophagogastric junction compliance without abnormal anatomy LES pressure in normal individuals is lowest after eating and highest at night. Even if the LES is relaxed, the pressure remains slightly higher than the intragastric pressure, to prevent reflux. ...
Gastroesophageal reflux disease (GERD) is a very common disease, and the prevalence in the general population has recently increased. GERD is a chronic relapsing disease associated with motility disorders of the upper gastrointestinal tract. Several factors are implicated in GERD, including hypotensive lower esophageal sphincter, frequent transient lower esophageal sphincter relaxation, esophageal hypersensitivity, reduced resistance of the esophageal mucosa against the refluxed contents, ineffective esophageal motility, abnormal bolus transport, deficits initiating secondary peristalsis, abnormal response to multiple rapid swallowing, and hiatal hernia. One or more of these mechanisms result in the reflux of stomach contents into the esophagus, delayed clearance of the refluxate, and the development of symptoms and/or complications. New techniques, such as 24-hour pH and multichannel intraluminal impedance monitoring, multichannel intraluminal impedance and esophageal manometry, high-resolution manometry, 3-dimensional highresolution manometry, enoscopic functional luminal imaging probe, and 24-hour dynamic esophageal manometry, provide more information on esophageal motility and have clarified the pathophysiology of GERD. Proton pump inhibitors remain the preferred pharmaceutical option to treat GERD. The ideal target of GERD treatment is to restore esophageal motility and reconstruct the antireflux mechanism. This review focuses on current advances in esophageal motor dysfunction in patients with GERD and the influence of these developments on GERD treatment.
... Disruption of the gastroesophageal barrier also occurs during transient lower esophageal sphincter relaxations (TLESRs) during which the LES relaxes to release excess gas from the stomach. TLESRs occur in the setting of gastric distention, which stimulates a vasovagal reflex and LES relaxation (11). Gastric distention may be secondary to ingestion of food or air and is exacerbated by alterations in gastric motility, which may be affected by type of oral intake and medications. ...
Gastroesophageal reflux disease (GERD) is a common esophageal disorder that is characterized by troublesome symptoms associated with increased esophageal acid exposure. Cornerstones of therapy include acid suppressive agents like proton pump inhibitors (PPI) and lifestyle modifications including dietary therapy, although the latter is not well defined. As concerns regarding long term PPI use continue to be explored, patients and providers are becoming increasingly interested in the role of diet in disease management. The following is a review of dietary therapy for GERD with an emphasis on the effect food components have on pathophysiology and management. Although sequential dietary elimination of food groups is common, literature supports broader manipulation including reduction of overall sugar intake, increase in dietary fiber, and changes in overall eating practices.
... It is also considered to be one of the major mechanisms of gastroesophageal reflux in GERD patients (Dent et al., 1980). In comparison to healthy individuals, the frequency of Transient LES relaxation is obviously upregulated in GERD patients (Kim et al., 2013). Recently developed high-resolution manometry has revealed that Transient LES relaxation exerts longitudinal muscle contraction of the esophageal body and relaxation of the LES ( Babaei et al., 2008). ...
Prostaglandin E2 (PGE2) plays a role in the pathogenesis of gastro-esophageal reflux disease (GERD). There are 4 subtypes of PGE2, PGE2 receptor 1, 2, 3 and 4 (EP 1-4). In GERD patents, PGE2, EP2 and EP4 are upregulated. However, the effects of PGE2 on esophageal motility remain elusive. We examined how PGE2 regulates motility in the porcine circular smooth muscle of the lower esophageal sphincter (LES), and the circular and longitudinal smooth muscle of the esophagus body in organ bath. PGE2 induced tonic relaxation in the LES and circular smooth muscle, but transient contraction in longitudinal smooth muscle. The relaxation of the LES and circular smooth muscle was similar in pattern and mechanism, but was much larger in the LES. The relaxation was completely blocked by a voltage-gated K+ channel blocker or 40 mM K+ depolarization, indicating the involvement of K+ channel. Longitudinal smooth muscle contraction was completely blocked by an L-type Ca2+ channel blocker, showing the contribution of Ca2+ movement. The involvement of the EP receptor in motility was examined with selective receptor agonists and antagonists. Activation of EP2 and EP4 caused relaxation in the LES and circular smooth muscle. Compatible with PGE2, EP2 and EP4 agonists caused more significant relaxation in the LES than in circular smooth muscle. EP1 contributed to the longitudinal smooth muscle contraction. The different effects of PGE2 in the LES, circular and longitudinal smooth muscle contributes to esophageal motility, their impairment might increase the amount and frequency of esophageal reflux.
... Under physiological conditions, these TLESRs are induced spontaneously without swallowing and allow for the "physiological" contact of gastric juice containing hydrochloric acid (HCl) with the esophageal wall [10]. Interestingly, this acid reflux occurs at a higher frequency during TLESR in patients with GERD than in healthy subjects [10,11]. Furthermore, the anatomical abnormalities in the structure of the lower esophageal sphincter or its dysfunction can result in more frequent or sometimes prolonged exposure of the esophageal mucosa to gastric acid, resulting in esophageal damage due to reflux esophagitis. ...
Turmeric obtained from the rhizomes of Curcuma longa has been used in the prevention and treatment of many diseases since the ancient times. Curcumin is the principal polyphenol isolated from turmeric, which exhibits anti-inflammatory, antioxidant, antiapoptotic, antitumor, and antimetastatic activities. The existing evidence indicates that curcumin can exert a wide range of beneficial pleiotropic properties in the gastrointestinal tract, such as protection against reflux esophagitis, Barrett's esophagus, and gastric mucosal damage induced by nonsteroidal anti-inflammatory drugs (NSAIDs) and necrotizing agents. The role of curcumin as an adjuvant in the treatment of a Helicobacter pylori infection in experimental animals and humans has recently been proposed. The evidence that this turmeric derivative inhibits the invasion and proliferation of gastric cancer cells is encouraging and warrants further experimental and clinical studies with newer formulations to support the inclusion of curcumin in cancer therapy regimens. This review was designed to analyze the existing data from in vitro and in vivo animal and human studies in order to highlight the mechanisms of therapeutic efficacy of curcumin in the protection and ulcer healing of the upper gastrointestinal tract, with a major focus on addressing the protection of the esophagus and stomach by this emerging compound.
