The impact of gastric distension on the lower esophageal sphincter and its exposure to acid gastric juice.

Abstract:

BACKGROUND AND AIMS:The lower esophageal sphincter (LES) in patients with gastroesophageal reflux disease often has a low resting pressure and a short abdominal length. The mechanism by which this occurs is unknown. We hypothesize that gastric distension causes progressive effacement of the abdominal portion of the LES, exposing it to acid injury resulting in mucosal and sphincter damage. Our aim was to assess in normal subjects the effect of gastric distension on the LES length and pressure and its exposure to acid gastric juice. METHODS:Eleven asymptomatic volunteers had their LES length and pressure measured before and during gastric distension. The location of the pH step-up point (shift from gastric pH to a pH >4) was also measured before and after distension. RESULTS:Progressive gastric distension with air resulted in progressive shortening of LES (R = 0.89, P < 0.0001). After infusion of 750 cc of air there was a significant reduction in the median LES length from 4 to 2.6 cm (P = 0.001). This change occurred in the abdominal length of the LES (2.6-1.4 cm [P = 0.001]) and not in the thoracic length. At rest the pH step-up point was 0.5 cm above the lower border of the LES and with distension moved a median of 1 cm cephalad within the LES. Simultaneously with the loss of length there was a reduction in LES pressure (27.4-23.4 mm Hg, P = 0.02). CONCLUSIONS:Gastric distension causes progressive shortening of the abdominal length of the LES and a reduction in its pressure. The process exposes the effaced mucosa and sphincter to acid gastric juice.

journal_name

Ann Surg

journal_title

Annals of surgery

authors

Ayazi S,Tamhankar A,DeMeester SR,Zehetner J,Wu C,Lipham JC,Hagen JA,DeMeester TR

doi

10.1097/SLA.0b013e3181e3e411

subject

Has Abstract

pub_date

2010-07-01 00:00:00

pages

57-62

issue

1

eissn

0003-4932

issn

1528-1140

journal_volume

252

pub_type

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