Upper sphincter function during transient lower oesophageal sphincter relaxation (tLOSR); It is mainly about microburps

J. E. Pandolfino*, S. K. Ghosh, Q. Zhang, A. Han, P. J. Kahrilas

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

43 Scopus citations

Abstract

Transient lower oesophageal sphincter relaxations (tLOSRs) are both a dominant mechanism of reflux and an element of the belch reflex. This study aimed to analyse the interplay between reflux and upper oesophageal sphincter (UOS) activity during meal-induced tLOSRs. Fifteen normal subjects were studied with a solid-state high-resolution manometry assembly positioned to record from the hypopharynx to the stomach and a catheter pH electrode 5 cm above the LOS. Subjects ate a 1000-calorie high-fat meal and were monitored for 120 min in a sitting posture. The relationship among tLOSRs, common cavities, pressure changes within the oesophagus and UOS contractile activity were analysed. A total of 218 tLOSRs occurred among the 15 subjects. The majority (79%) were coupled with UOS relaxation and 84% (145/173) of these occurred in association with a common cavity. Upper oesophageal sphincter relaxation was usually preceded by a pressure change in the oesophagus; however, some relaxations (16%) occurred without a discernable increase in pressure or before the pressure increase began. Acid reflux did not appear to play a role in determining UOS response to tLOSRs. The majority of post-prandial tLOSRs were associated with brief periods of UOS relaxation, likely permissive of gas venting (microburps). Intraoesophageal pressure changes likely modulate this UOS response; however, an anticipatory characteristic was evident in some subjects. Whether or not GORD patients with extra-oesophageal symptoms exhibit an exaggeration of the UOS relaxation response during reflux is yet to be determined.

Original languageEnglish (US)
Pages (from-to)203-210
Number of pages8
JournalNeurogastroenterology and Motility
Volume19
Issue number3
DOIs
StatePublished - Mar 2007

Keywords

  • High-resolution manometry
  • Transient lower oesophageal sphincter relaxation
  • Upper oesophageal sphincter

ASJC Scopus subject areas

  • Physiology
  • Endocrine and Autonomic Systems
  • Gastroenterology

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