Please use this identifier to cite or link to this item: https://hdl.handle.net/2440/103019
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Type: Journal article
Title: Intra-bolus pressure and esophagogastric gradient, assessed with high-resolution manometry, are associated with acid exposure and proximal migration of refluxate
Author: Ribolsi, M.
Balestrieri, P.
Holloway, R.
Emerenziani, S.
Cicala, M.
Citation: Diseases of the Esophagus, 2016; 29(8):1020-1026
Publisher: Wiley
Issue Date: 2016
ISSN: 1120-8694
1442-2050
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Responsibility: 
Mentore Ribolsi, P. Balestrieri, R. H Holloway, S. Emerenziani, M. Cicala
Abstract: Trans-sphincteric pressure gradient (TSPG) seems to play a relevant role in eliciting refluxes during transient lower esophageal sphincter relaxations (TLESRs). Intra-bolus pressure (IBP) is considered to be correlated to esophageal wall tone. We aimed to evaluate the relationship between IBP, TSPG during TLESRs and the dynamic properties of refluxate in gastroesophageal reflux disease. Sixteen non-erosive reflux disease (NERD), 10 erosive disease (ERD) patients and 12 healthy volunteers (HVs), underwent 24-hour impedance-pH monitoring and combined high-resolution manometry-impedance before and 60 minutes. After a meal, ERD patients presented a significantly lower mean IBP (4.7 ± 1.6 mmHg) respect to NERD patients (8.9 ± 2.8 mmHg) and HVs (9.2 ± 3.2 mmHg). NERD patients with physiological abnormal acid exposure time showed a mean IBP (10.4 ± 3.1 mmHg) significantly higher than that in NERD with pathological abnormal acid exposure time (5.1 ± 1.5 mmHg). The TSPG value was significantly higher during TLESRs accompanied by reflux than during TLESRs not associated with reflux, both in patients and in HVs. A significant direct correlation was found between IBP, TSPG and proximal spread of refluxes in patients and in HVs. Gastroesophageal reflux disease patients display different degrees of esophageal distension. An increased compliance of the distal esophagus may accommodate larger volumes of refluxate and likely facilitates the injuries development. Higher TSPG values appear to facilitate the occurrence of refluxes during TLESRs. In patients with NERD, higher TSPG and IBP values favor proximal spread of refluxate and hence may play a relevant role in symptom generation.
Keywords: GERD
HRM
TLESR
intra-bolus pressure
trans-sphincteric pressure gradient
Rights: © 2015 International Society for Diseases of the Esophagus
DOI: 10.1111/dote.12434
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