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Type: Journal article
Title: Effect of hyperglycemia on triggering of transient lower esophageal sphincter relaxations
Author: Zhang, Q.
Horowitz, M.
Tippett, R.
Rayner, C.
Worynski, A.
Holloway, R.
Citation: American Journal of Physiology: Gastrointestinal and Liver Physiology, 2004; 286(5):G797-G803
Publisher: Amer Physiological Soc
Issue Date: 2004
ISSN: 0193-1857
Statement of
Qing Zhang, Michael Horowitz, Rachael Rigda, Christopher Rayner, Andrew Worynski, and Richard H. Holloway
Abstract: Acute changes in blood glucose concentration have major effects on gastrointestinal motor function. Patients with diabetes mellitus have an increased prevalence of gastroesophageal reflux. Transient lower esophageal sphincter (LES) relaxation (TLESR) is the most common sphincter mechanism underlying reflux. The aim of this study was to investigate the effect of acute hyperglycemia on triggering TLESRs evoked by gastric distension in healthy volunteers. TLESRs were stimulated by pressure-controlled and volume-controlled (500 ml) gastric distension using an electronic barostat and performed on separate days. On each day, esophageal manometry was performed in the sitting position during gastric distension for 1 h under euglycemia (5 mM), and either marked hyperglycemia (15 mM) or physiological hyperglycemia (8 mM) in randomized order was maintained by a glucose clamp. Marked hyperglycemia doubled the rate of TLESRs in response to both pressure-controlled [5 (3–10.5, median or interquartile range) to 10 (9.5–14.5) per hour, P < 0.02] and volume-controlled [4 (2.5–7.5) to 10.5 (7–12.5) per hour, P < 0.02] gastric distension but had no effect on basal LES pressure. Physiological hyperglycemia had no effect on the triggering of TLESRs or basal LES pressure. In healthy human subjects, marked hyperglycemia increases the rate of TLESRs. Increase in the rate of TLESRs is independent of proximal gastric wall tension. Mechanisms underlying the effect remain to be determined. Hyperglycemia may be an important factor contributing to the increased esophageal acid exposure in patients with diabetes mellitus.
Keywords: diabetes mellitus
esophageal motility
gastroesophageal relux disease
Description: © 2005 by the American Physiological Society. Published abstract reprinted by permission of the copyright owner.
DOI: 10.1152/ajpgi.00383.2003
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