Characteristics Of Esophageal Motility And Acid Reflux In Patients With Gastroesophageal Reflux Disease

PartⅠPatients with Gastroesophageal Reflux Disease and Healthy Volunteers Comparison of esophageal motility and gastroesophageal reflux characteristicsObjectives: To evaluate the pressure and motor pattern of lower esophageal sphincter (LES) and characteristics of gastroesophageal reflux during fasting and postprandial hours in the patients with reflux esophagitis (RE) and nonerosive reflux disease (NERD) and in healthy controls. Methods: 10 healthy volunteers and 13 RE patients and 13 NERD patients participated in the study. LES pressure (LESP) and intraluminal acidity were simultaneously recorded 1 h during fasting and 3 h after a liquid meal using esophageal manometry and pH monitoring devices. Results:①The basal LESP of healthy controls(14.17±0.85 mm Hg)was significantly higher than RE patients(7.24±0.82 mm Hg, P=0.000)and NERD patients(9.71±1.54 mm Hg, P=0.021), no difference was found between RE patients and NERD patients(P=0.173). A significant decrease in LESP was observed during the postprandial period, especially in RE and NERD patients, and could not recover after 3 h.②Amplitude of peristalsis of middle and lower esophagus in RE patients as well as that of middle esophagus in NERD patients were lower than controls (P<0.05). The percentage of successful wet swallowing in RE and NERD patients was significantly lower than that in controls(P=0.000,0.006). Esophageal body motor function of RE patients was similar to that of NERD patients.③RE and NERD patients showed a greater number of transient lower esophageal sphincter relaxations (TLESRs) during postprandial hours as compared to healthy controls, but it was similar in three groups during fasting hour. A small percentage of TLESRs was followed by reflux episodes in healthy controls(21.4%)and NERD patients(27.80%), with a significant increase(P =0.003, 0.031)in RE patients(38.20%). The percentage of TLESRs accompanied by weakly acidic reflux in NERD patients (34.30%) was higher than healthy controls(17.90%, P =0.002 )and RE patients (21.90%, P =0.008).④The RE patients showed greater number of acid reflux episodes during the first and second postprandial hours as compared to healthy controls(P=0.032, 0.014),and the % time with pH < 4 during postprandial hours of RE patients was also higher than that of healthy controls and NERD patients(P<0.05). There was no significant difference between healthy controls and NERD patients. The NERD patient demonstrated more weakly acidic reflux episodes during the first and second postprandial hours than healthy controls (P=0.006, 0.022), and that was similar in healthy controls and RE patients.⑤Most acid reflux episode in RE and NERD patients occurred during TLESRs(48.92%,55.10%)and persisting low basal LES pressure(24.46%,19.39%), while most occurred during TLESRs(45.28%)and LES relaxation induced by dry swallowing(30.19%)in healthy controls, only 3.77% occurred in persisting low basal LES pressure in healthy controls. Conclusions: It is established that impaired LES function plays an important role in RE and NERD patients, TLESRs and persisting low basal LES pressure represent important motor patterns during gastroesophageal reflux.PartⅡEffects of Domperidone on Esophageal Motility and Acid RefluxObjectives: To evaluate the effect of domperidone on the motor pattern and function of lower esophageal sphincter (LES), transient lower esophageal sphincter relaxations ( TLESRs ) and gastroesophageal reflux in healthy subjects and patients with gastroesophageal reflux disease. Methods: 10 healthy volunteers and 13 reflux esophagitis (RE) patients and 13 non-erosive reflux disease (NERD) patients participated in a randomized study on two separate days after oral intake of either domperidone 60mg or placebo. LES pressure (LESP) and intraluminal acidity were simultaneously recorded 1 h during fasting and 3 h after a liquid meal using esophageal manometry and pH monitoring devices. Results: (1) Domperidone significantly increased LESP and prolonged, but it was more effective in 11 patients with defective LES (LESP<7mm Hg) than in healthy subjects. (2) No alteration on esophageal body motility was found after oral intake of domperidone in healthy volunteers. Total 22 patients with abnormal peristalsis demonstrated significantly increased velocity of peristaltic wave and percentage of successful wet swallowing at 30 min and 60 min after ingestion of domperidone, but the amplitude of peristalsis wave in the esophagus was not significantly influenced by domperidone both before and after meal intake(P>0.05). (3)Domperidone did not significantly influence TLESR frequency, neither under basal conditions, nor postprandially. But domperidone induced a significant decrease in the percentage of TLESRs accompanied by acid reflux both in healthy subjects (8.30% vs 21.40%,P=0.007)and RE patients(12.90% vs 38.20%,P=0.000) and NERD patients (10.20% vs 27.80%,P=0.000), and induced a significant decrease in the percentage of TLESRs accompanied by weakly acidic reflux in NERD patients (19.30% vs 34.30%,P=0.001). (4) In healthy subjects, acid reflux episodes were significantly decreased during the first hour after oral intake of domperidone (0.50±0.97 vs 0.90±1.20, P=0.046). Domperidone also reduced both the number of reflux episodes and % time with pH < 4 after meal ingestion in RE and NERD patients, and decreased weakly acidic reflux episodes during postprandial hours in RE and NERD patients. (5) The mechanisms of acid reflux and weakly acidic reflux were not altered by domperidone. Conclusions: Acute oral administration of high dose domperidone significantly increases the LESP and decreases the acid reflux episodes and percentage of TLESR accompanied by acid reflux and weakly acidic reflux. This strategy might be able to reduce gastroesophageal reflux safely for patients with moderate-severe gastroesophageal reflux disease. PartⅢEsophageal motility in different age groups of healthy subjects and patients with gastroesophageal reflux diseaseObjectives: To evaluate the difference of esophageal motility between age groups. Methods: Standard esophageal manometry was performed in 83 healthy volunteers and 300 patients with typical reflux symptoms. Results: The resting lower esophageal sphincter pressure (LESP) was highest in 51-64 yr-old healthy volunteers compared with the or=65- yr-old groups(P=0.048, 0.023). But LESP was similar regardless of age in GERD patients (P>0.05). The percentage of defective LES in patients with GERD was analyzed, no significant difference was found between four age groups (P>0.05). Age correlated inversely with peristaltic wave velocity both in healthy subjects and patients(r=-0.338,-0.138;P=0.002,0.017), and correlated inversely with the percentage of successful wet swallowing in patients(r=-0.144;P=0.012). However, there were no differences of the percentage of successful wet swallowing between four age groups in healthy subjects (P>0.05). The amplitude of peristalsis was similar in four age groups both in healthy subjects and patients (P>0.05). No significant difference was found between four age groups for the rate of abnormal peristalsis in patients with GERD (P>0.05). Conclusions: The results suggest that esophageal peristaltic wave velocity decreases with advancing age both in patients and healthy subjects,and the percentage of successful wet swallowing also decreases with advancing age in patients with GERD.PartⅣGender differences of esophageal motility in symptomatic patients with gastroesophageal reflux disease and healthy subjectsObjectives: To evaluate the effect of gender on esophageal motility. Methods: Standard esophageal manometry was performed in 300 patients with typical reflux symptoms including 104 reflux esophagitis (RE) and 196 non-erosive reflux disease (NERD), and in 83 healthy volunteers. Results: RE was more common in males (69.2%). In healthy volunteers and NERD patients, the resting lower esophageal sphincter pressure (LESP) was lower in males than that in females(P=0.001,0.006). The percentage of defective LES in patients with RE and NERD were analyzed, gender differences were observed in NERD patients (men: 45.9%;women: 29.7%,P=0.020). But no gender difference was found in RE patients (P=0.794). The percentage of successful wet swallowing of males were lower than that of females in patients with RE(P=0.003), while there no gender differences in healthy volunteers and NERD patients(P=0.552, 0.550). Normal females had significantly higher amplitude of peristalsis of proximal esophagus than male(sP=0.017). No gender difference of the amplitude of peristalsis was found in patients with RE and NERD (P>0.05). Gender differences were observed for the rate of abnormal peristalsis in RE patients (men: 68.1%; women: 46.9%, P=0.040). Conclusions: The results suggest that gender may cause some differences in esophageal motility,and male may be a risk factor for GERD.