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Mechanisms of esophago-pharyngeal acid regurgitation in human subjects.

Szczesniak MM, Williams RB, Cook IJ - PLoS ONE (2011)

Bottom Line: A total of 32 episodes of spontaneous esophago-pharyngeal acid regurgitation were recorded.All episodes occurred in the upright posture and 91% occurred within 3 hrs post-prandium.The dominant mechanism underlying esophago-pharyngeal acid regurgitation is the non-swallow related, transient UES relaxation.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, University of New South Wales and St George Hospital, Sydney, New South Wales, Australia. m.szczesniak@unsw.edu.au

ABSTRACT

Unlabelled: Esophago-pharyngeal regurgitation is implicated in various otolaryngologic and respiratory disorders. The pathophysiological mechanisms causing regurgitation are still largely unknown.

Aim: To determine the principal mechanisms behind esophago-pharyngeal regurgitation.

Methods: We studied 11 patients with extra-esophageal GORD symptoms in whom esophago-pharyngeal acid regurgitation had previously been demonstrated using ambulatory, dual (pharyngo-esophageal) pH metry (>2 episodes/day using previously validated pH-metric criteria). Patients underwent continuous, 24 hr, stationary monitoring of pharyngo-esophageal manometry and dual (pharyngeal and esophageal) pH recordings. They were intubated with a 14-channel manometric assembly incorporating 2 sleeve sensors monitoring the upper and lower esophageal sphincters simultaneously. A dual pH catheter recorded pH signals 2 cm above the UES midpoint and 7 cm above the LES midpoint.

Results: A total of 32 episodes of spontaneous esophago-pharyngeal acid regurgitation were recorded. All episodes occurred in the upright posture and 91% occurred within 3 hrs post-prandium. All regurgitation events were associated with a relaxation of the UES, which were classified as transient non-swallow related relaxations in 29 (91%) and swallow-related in the remaining 3 (9%). Straining was an additional associated factor in 41% of regurgitation events, but strain alone was not sufficient to cause esophago-pharyngeal regurgitation.

Conclusion: Some form of active UES relaxation is necessary for regurgitation to occur. The dominant mechanism underlying esophago-pharyngeal acid regurgitation is the non-swallow related, transient UES relaxation.

Level of evidence: N/A.

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Related in: MedlinePlus

Frequency distribution of all esophago-pharyngeal regurgitation events according to time delay between onset of gastro-esophageal reflux and onset of pharyngeal regurgitation (ΔT).Stratified according to presence of strain (A) and common-cavity (B).
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pone-0022630-g005: Frequency distribution of all esophago-pharyngeal regurgitation events according to time delay between onset of gastro-esophageal reflux and onset of pharyngeal regurgitation (ΔT).Stratified according to presence of strain (A) and common-cavity (B).

Mentions: We measured the time delay between onset of gastro-esophageal reflux and subsequent esophago-pharyngeal regurgitation defined as the time lapsed between the onset of esophageal pH drop or a common-cavity and the onset of the pharyngeal pH drop. Sixty percent of all the regurgitation events occurred rapidly within 10 s of a gastro-esophageal reflux event and the remaining events were spaced equally in time as long as 11 min after the antecedant esophageal pH drop. The strain pattern was seen in relation to both immediate (<2 s) and delayed regurgitation events (>30 s). However, the strain pattern was significantly more likely to occur in relation to the delayed events (χ2, p<0.05) (Fig 5). Hence, strain seems to facilitate regurgitation but only in the context of a pre-existing UES relaxation.


Mechanisms of esophago-pharyngeal acid regurgitation in human subjects.

Szczesniak MM, Williams RB, Cook IJ - PLoS ONE (2011)

Frequency distribution of all esophago-pharyngeal regurgitation events according to time delay between onset of gastro-esophageal reflux and onset of pharyngeal regurgitation (ΔT).Stratified according to presence of strain (A) and common-cavity (B).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3142175&req=5

pone-0022630-g005: Frequency distribution of all esophago-pharyngeal regurgitation events according to time delay between onset of gastro-esophageal reflux and onset of pharyngeal regurgitation (ΔT).Stratified according to presence of strain (A) and common-cavity (B).
Mentions: We measured the time delay between onset of gastro-esophageal reflux and subsequent esophago-pharyngeal regurgitation defined as the time lapsed between the onset of esophageal pH drop or a common-cavity and the onset of the pharyngeal pH drop. Sixty percent of all the regurgitation events occurred rapidly within 10 s of a gastro-esophageal reflux event and the remaining events were spaced equally in time as long as 11 min after the antecedant esophageal pH drop. The strain pattern was seen in relation to both immediate (<2 s) and delayed regurgitation events (>30 s). However, the strain pattern was significantly more likely to occur in relation to the delayed events (χ2, p<0.05) (Fig 5). Hence, strain seems to facilitate regurgitation but only in the context of a pre-existing UES relaxation.

Bottom Line: A total of 32 episodes of spontaneous esophago-pharyngeal acid regurgitation were recorded.All episodes occurred in the upright posture and 91% occurred within 3 hrs post-prandium.The dominant mechanism underlying esophago-pharyngeal acid regurgitation is the non-swallow related, transient UES relaxation.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, University of New South Wales and St George Hospital, Sydney, New South Wales, Australia. m.szczesniak@unsw.edu.au

ABSTRACT

Unlabelled: Esophago-pharyngeal regurgitation is implicated in various otolaryngologic and respiratory disorders. The pathophysiological mechanisms causing regurgitation are still largely unknown.

Aim: To determine the principal mechanisms behind esophago-pharyngeal regurgitation.

Methods: We studied 11 patients with extra-esophageal GORD symptoms in whom esophago-pharyngeal acid regurgitation had previously been demonstrated using ambulatory, dual (pharyngo-esophageal) pH metry (>2 episodes/day using previously validated pH-metric criteria). Patients underwent continuous, 24 hr, stationary monitoring of pharyngo-esophageal manometry and dual (pharyngeal and esophageal) pH recordings. They were intubated with a 14-channel manometric assembly incorporating 2 sleeve sensors monitoring the upper and lower esophageal sphincters simultaneously. A dual pH catheter recorded pH signals 2 cm above the UES midpoint and 7 cm above the LES midpoint.

Results: A total of 32 episodes of spontaneous esophago-pharyngeal acid regurgitation were recorded. All episodes occurred in the upright posture and 91% occurred within 3 hrs post-prandium. All regurgitation events were associated with a relaxation of the UES, which were classified as transient non-swallow related relaxations in 29 (91%) and swallow-related in the remaining 3 (9%). Straining was an additional associated factor in 41% of regurgitation events, but strain alone was not sufficient to cause esophago-pharyngeal regurgitation.

Conclusion: Some form of active UES relaxation is necessary for regurgitation to occur. The dominant mechanism underlying esophago-pharyngeal acid regurgitation is the non-swallow related, transient UES relaxation.

Level of evidence: N/A.

Show MeSH
Related in: MedlinePlus