Effect of Gastrin-17 on Lower Esophageal Sphincter Characteristics in Man

We studied the effect of gastrin-17 on loweresophageal sphincter (LES) characteristics in man. Ninehealthy volunteers participated in two experimentsperformed in random order during continuous infusion of saline (control) or gastrin-17 (15pmol/kg/hr). LES pressure (LESP) and transient loweresophageal sphincter relaxations (TLESR), as most theimportant reflux mechanism, were measured withintraesophageal sleeve manometry combined with pH metry.Infusion of gastrin-17 resulted in plasma gastrin levelscomparable to those reached after a mixed meal. Duringcontinuous gastrin infusion, LESP decreasedsignificantly (P 0.05) compared to control. The rate andduration of TLESR was not influenced by gastrin-17.Gastroesophageal reflux and the number of TLESRassociated with reflux were significantly (P 0.05)increased during gastrin infusion. These results suggestthat in humans gastrin at physiological postprandialplasma concentrations decreases LESP, does not influenceTLESR, but increases the percentage of TLESR associated with reflux.     

Gastroesophageal Reflux After Combined Lower Esophageal Sphincter and Diaphragmatic Crural Sling Inactivation in the Rat

This study tests the hypothesis that eitherselective or combined destruction of the loweresophageal sphincter and the diaphragmatic crural slingshould induce reflux in the rat. Pull-through perfusion manometry was performed before and after loweresophageal myectomy, crural myotomy, or both. pHmonitoring was used to detect reflux. Unmanipulated ratsserved as controls. Paired t tests were used for comparison of pre- and postoperative pressurevalues and contingency tables with Fisher's tests forexamining the association between the interventions andthe appearance of reflux. Esophageal myectomy decreased only sphincteric pressure from 25.9± 15.5 to 9 ± 6 mm Hg (P < 0.01),whereas crural myotomy decreased only sling pressurefrom 26.2 ± 13.3 to 7.3 ± 3.9 mm Hg (P< 0.01). Simultaneous performance of both procedures decreasedsphincteric and crural pressures from 20.4 ± 7.5to 7.6 ± 4.3 mm Hg (P < 0.01) and from 45.9± 20.6 to 18.2 ± 7.4 mm Hg (P < 0.01),respectively. None of the control, myectomy, or myotomy animalsshowed reflux upon pH-metry but 5/8 rats in which bothprocedures were performed had prolonged acid exposure.No esophagitis was seen. In conclusion, normal rats do not have reflux. Selective destructionof either the sphincter or the crural sling does notinduce reflux, despite causing flattening of theirrespective manometric profiles. Conversely, combined inactivation of both components issignificantly associated with reflux.     

Globus Sensation Is Associated with Hypertensive Upper Esophageal Sphincter but Not with Gastroesophageal Reflux

Globus sensation (globus) is best described asa constant feeling of a lump or fullness in the throat.Although the etiology of globus remains unclear, it hasbeen attributed to a hypertensive upper esophageal sphincter (UES) resting pressure and togastroesophageal reflux (GER). The aim of this studywas, therefore, to determine if significant associationsexisted among globus, UES resting pressure, and GER. We reviewed the records of all patients who hadstationary esophageal manometry over a 21 -year intervalwith specific attention to symptoms of globus, UESpressures, and ambulatory pH studies. Patients with hypotensive UES (<30 mm Hg) wereexcluded. Chi square (²) test was usedto determine significant associations. Six hundred fiftypatients had normal UES resting pressures and 101patients had hypertensive UES (>118 mm Hg). Seventeen ofthe 650 (3%) (16 women/1 man; mean age: 48, range 32-81years) with normal UES described globus. Conversely, 28of the 101 (28%) (15 women/13 men; mean age: 43, range 23- 61 years) patients withhypertensive UES described globus. There was asignificant association between hypertonicity of the UESand globus (² = 93.42, P < 0.0001).In patients with normal UES, globus occurred predominantly infemales (² = 6.33, P < 0.01).Twenty-three (16 women/7 men; mean age: 43, range 23-60years) of the 45 patients with globus had priorambulatory pH studies. Six of 23 (26%) had GER. Compared to an age-,sex-, and UES-pressure-matched group of 23 patients (16women/7 men; mean age: 44, range 22-75 years) withoutglobus, nine (39%) had GER, thus showing no significant association of globus with GER (P = 0.35).There also was no significant association of GER withnormal UES or with hypertensive UES in these patients.In conclusion, there is a significant association between hypertensive UES and globus. The datasuggest two possible etiologies: female patients withnormal UES pressure potentially having increasedafferent sensation and a group with equal sexdistribution but abnormally elevated UES resting pressure.This study does not support GER as an etiology ofglobus.     

Effects of Omeprazole on Mechanisms of Gastroesophageal Reflux in Childhood

Prolonged recordings of esophageal motility haveshown that dynamic changes of lower esophageal sphincter(LES) pressure such as transient LES relaxation and LESpressure drifts are the most common mechanisms underlying gastroesophageal reflux (GER). Thecoexistence of a delayed gastric emptying has also beenreported in a high proportion of patients with refluxdisease. However, not much information is available on the effects of antireflux therapy on thepathogenetic mechanisms of GER. The purpose of thisstudy was to determine in a group of children withsevere reflux disease the effect of omeprazole therapy on motor changes of LES underlying GER as wellas on gastric emptying time. Twenty-two children (medianage: 6.6 years) with GER disease, refractory to combinedranitidine and cisapride administration, entered into an eight-week omeprazole course.Ten subjects with moderate GER disease served ascontrols (median age: 6.0 years). Before and afteromeprazole administration, the following variables were assessed: esophagitis grading, fasting and fedsimultaneous prolonged recording of distal esophagealsphincter pressure (with a sleeve catheter) andintraesophageal pH, LES and esophageal peristalsisamplitude, and gastric emptying time of a mixedsolid-liquid meal (measured with gastric ultrasound). Ascompared to controls, patients showed a higher rate oftransient LES relaxation and LES pressure drift (P <0.01), a reduced amplitude of basal sphincter pressure(P < 0.01) and peristalsis (P < 0.05), and a moreprolonged gastric emptying time (P < 0.05). Afterending omeprazole, there was no significant change inany of the motor abnormalities of the esophagus and ingastric emptying time despite a marked improvement ofsymptoms and esophagitis in all patients. Sixteenpatients were symptomatic when reevaluated on a clinical basis two months after ending therapy. Weconclude that in children with severe GER disease, anabnormally high rate of both transient LES relaxationand LES pressure drift and slow gastric emptying are not affected by omperazole treatment, eventhough esophageal mucosal damage is markedly improved orcured. These abnormalities represent a primary motordisorder and can be implicated in the refractoriness of reflux disease.     

Obesity Correlates with Gastroesophageal Reflux

Thirty morbidly obese patients presenting forbariatric surgery were evaluated for symptomatic andobjective evidence of gastroesophageal reflux. Sixteenpatients had heartburn while 14 were asymptomatic. All underwent esophageal function testing;manometry was performed in all patients, pH monitoringin 28. Patients with esophageal pH < 4 for more than5% of observed time weighed more than those with normal acid exposure, 165.2 vs 129.8 kg (P <0.01), and had significantly higher body mass indices,56.5 vs 48.3 kg/m² (P < 0.05). Similarly,morbidly obese patients with abnormal reflux scores weighed significantly more and hadgreater body mass indices than patients with normalscores (P < 0.05). Lower esophageal sphincterpressure was higher in patients with normal esophagealacid exposure than in those with abnormal findings,15.5 vs 12.5 mm Hg (P < 0.05). This studydemonstrates a correlation between both weight and bodymass index with gastroesophageal reflux.     

Esophageal Swallowing Phase Assessed by Audiosignal Recording (Relationship with Manometry in Gastroesophageal Reflux Disease Patients)

The acoustic technique has been used forpharyngeal exploration but to date no such technique hasbeen devised to assess esophageal motility. The aim ofthis study was to demonstrate that displacement through the esophagus can be quantified using thismethod in healthy subjects and in patients withgastroesophageal reflux. Concurrent manometric andacoustic recordings were also performed in the patients.Fifteen controls (38.5 ± 13 years old) and 10patients (34.9 ± 6 years old) were included. Allwere recorded during wet and dry swallow sequences withmicrophones placed below the cricoid cartilage and onthe xiphoid appendix. Standard manometry wasperformed for lower esophageal sphincter (LES)exploration. For the acoustic technique, the frequencyof xiphoid signals (FX), esophageal transit time (ETT),duration of xiphoid sound (SD), and for the manometricstudy, the duration of LES relaxation (RD) were recordedand mean values were calculated (FXm), (ETTm), (SDm),(RDm). FXm for wet (94 vs 81.6%) and dry swallows (86 vs 66.6%) decreased in patients. ETTm wassignificantly higher (P < 0.01) for wet than for dryswallows (5.6 ± 0.9 vs 5.2 ± 1.2 sec) forcontrols but not for patients. ETTm was significantly higher for patients for wet (7.2 ± 2.1sec) and for dry swallows (6.5 ± 2.3 sec) thanfor controls and SDm was lower. Xiphoid sound appearedin the second half of LES relaxation. Our noninvasiveacoustic technique is simple and reproducible. It iswell correlated with manometry, and it allowscharacterization of the displacement of the bolusthrough the esophagus and the LES. The technique couldbe used alone to determine appropriate pharmacologicaland surgical treatments for esophageal motilitydisorders.     

Effects of Octreotide on Lower Esophageal Sphincter in Patients with Cirrhosis and Portal Hypertension

We investigated the effects of octreotide infusion on the contractile activity of the esophageal body and lower esophageal sphincter in cirrhotic patients with esophageal varices. Esophageal manometry was performed in 36 alcoholic cirrhotic patients. They were randomly allocated to three groups and received the following treatments blindly for 90 min: an initial 100-g intravenous bolus followed by a continuous 25 g/hr octreotide infusion (group I, N = 13), a continuous 25 g/hr octreotide infusion without an initial bolus (group II, N = 13), and a continuous placebo infusion (group III, N = 10). Before drug infusion, mean lower esophageal sphincter pressure and mean esophageal body contraction pressure and duration were similar in the three groups. Compared to the placebo group, lower esophageal sphincter pressure increased significantly in groups I and II, 30 min (30%, 22%, 3% respectively; P = 0.006), 60 min (44%, 35%, 0.6%; P = 0.0002), and 90 min (67%, 41%, 2.5%; P = 0.0001) after octreotide infusion, as did esophageal body contraction pressure and duration. We conclude that octreotide has a potent effect on LES tone in cirrhotic patients.     

Four-Channel Sleeve Catheter for Prolonged Measurement of Lower Esophageal Sphincter Pressure

A sleeve catheter capable of monitoring thelower esophageal sphincter (LES) pressure in fourquadrants at right angels has been developed. Thepresent study used this four-quadrant sleeve catheter toassess radial asymmetry in LES in the supine, prone,and upright positions. The results in 37 normal subjectswere compared with those of a conventional side-holecatheter and a Dent sleeve catheter. In vitro studies showed that the response rate of eachradially oriented sleeve is comparable to the Dentsleeve. Mean pressures were not significantly differentbetween the three different types of catheter. The four-quadrant sleeve catheter consistentlydetected a higher LES pressure in the left posteriorposition, regardless of body position. The four quadrantsleeve catheter can be used to record LES pressure from four different quadrants of the LES forprolonged periods.     

Esophageal and Lower Response to Balloon Distention in Patients with Achalasia Esophageal Sphincter

Achalasia is characterized by absent orincomplete lower esophageal sphincter (LES) relaxationand aperistalsis in the smooth muscle esophageal body inresponse to swallowing. The esophageal and LES response to distention has not previously been studied.I aimed to characterize the responses to esophagealballoon distention in achalasia patients in comparisonto controls. Sixteen consecutive achalasia patients and 11 healthy volunteers underwent standardesophageal manometry followed by graded midesophagealballoon distention during which LES (as measured by theDent sleeve) and esophageal body pressures were monitored. Subject perception of distention wasalso recorded using a standardized scoring system. TheLES relaxation response to esophageal balloon distentionwas markedly impaired in achalasia patients, irrespective of whether the patient hadradiological evidence of a dilated or nondilatedesophagus. However, phasic contractions proximal to thedistending balloon were preserved. The esophageal bodyresponses below the balloon were inconsistent in bothgroups, and not significantly different from oneanother. Pain-sensation scores were significantly lowerin achalasia patients at the highest distending volumes, but this difference was attributable to thesubgroup of patients with a dilated esophagus.Distention-induced LES relaxation is markedly impairedin achalasia patients in keeping with loss of intrinsic inhibitory innervation. Preservation of theproximal excitation suggests that extrinsic vagalreflexes are intact.     

Esophageal Dysmotility and Gastroesophageal Reflux in Intrinsic Asthma

This study was undertaken to determine theprevalence of esophageal motor abnormalities, theincidence of gastroesophageal reflux, and thecoexistence of gastroesophageal reflux with esophagealdysmotility in patients with intrinsic asthma. Based onclinical criteria, 34 consecutive asthmatics, 15patients with gastroesophageal reflux, and 10 subjectswith upper gastrointestinal symptoms with normal results of esophageal manometry and 24-hr esophageal pHtest (controls) were studied. Esophageal motor disorderswere noted in 23 of 34 asthmatics, and in 10 of 15patients with acid reflux but in none of the subjects of the control group. A positive result of theprolonged esophageal pH study (pH in the distalesophagus less than 4 for more than 4.2% of therecording time) was obtained in 14 of 17 patients withasthma (only 17 of the original patients were testedbecause the others did not give informed consence forthis test) and in all patients with gastroesophagealreflux. None of the members of the control group had positive test results. The findings of thisstudy show that: (1) it is possible to identify a groupof subjects with nonallergic asthma presenting withesophageal dysmotility, (2) the 24-hr esophageal pH study must be properly done in suchpatients; (3) esophageal motor abnormalities are oftenassociated with positive pH results; and (4) more refluxwas observed while in a supine position (especially during the night) than that observed either incontrol or reflux patients. Based on these results,patients with intrinsic asthma with reflux can benefitfrom both acid suppressive and prokinetic drugs with notable clinical implications regardingstandard treatment for asthma, and those with prevalentsupine compared to upright reflux could even benefitfrom surgery.     

Gastroesophageal Reflux Disease (Relationship Between Clinical and Histological Features)

Our purpose was to evaluate the relationshipbetween the clinical and histological features in acohort of patients who had gastroesophagealreflux-related lesions diagnosed after upper digestiveendoscopy. In all, 589 patients scheduled for electiveendoscopy in a multicentric prospective study wereevaluated. Multiple biopsies from the distal esophagusshowing aspects of esophagitis or metaplastic epithelium were taken. Esophagitis was histologicallydetected in 25.6%, gastric-type Barrett's esophagus in36.2%, and specialized columnar epithelium in 33.1%. Thefrequency of esophagitis was constant across age decades. Patients with specialized columnarepithelium were significantly older (P = 0.01) and hada greater extent of metaplastic epithelium (P <0.0001). Specialized columnar epithelium was observed in 15% of patients with only distalesophagitis. In conclusion, endoscopic esophagitis wasconstant across age strata. The presence of specializedcolumnar epithelium was associated with older age andwith longer segments of Barrett's esophagus. Shortareas of esophagitis should be biopsied in view of theirpotential for holding areas of specialized columnarepithelium.     

Symptomatic Gastroesophageal Reflux in Acutely Hospitalized Patients

Patients admitted acutely to hospital may be atrisk of increased morbidity and mortality as a result ofgastroesophageal reflux and its complications. Therecognized association of gastroesophageal reflux with cardiac and respiratory disease, the useof drugs that reduce lower esophageal sphincterpressure, and the supine position in which many patientsare nursed may increase the risk of gastroesophageal reflux. This study aimed to determine theprevalence and severity of refluxlike symptoms in aseries of consecutive unselected patients admittedacutely through the accident and emergency department of a district general hospital and to study theeffect of hospitalization on these symptoms. Patientswere interviewed by questionnaire on two occasions:immediately following admission and again 7-10 days later. The frequency of symptoms of heartburn,acid regurgitation, dysphagia, nausea, and belching wererecorded on a 6-point scale, in addition to whetherthese symptoms occurred at night. Medication history, the number of days spent on bed rest,nasogastric intubation, and operation history were alsorecorded. In all, 275 patients were interviewed, of whom229 had a second interview; 27% (62) had symptoms at least once a week (49% reported symptoms atleast once a month) prior to admission, of whom 4% (9)had daily heartburn and/or acid regurgitation. Followingadmission to hospital there was a significant (P < 0.001) fall in the prevalence andfrequency of refluxlike symptoms. There was asignificant association of refluxlike symptoms withnumber of days spent in bed (P < 0.05) and with theuse of nonsteroidal antiinflammatory drugs in hospital(P < 0.0001). Logistic regression analysis confirmedthe association of NSAIDs with refluxlike symptoms.Nasogastric intubation and surgery were not associated with heartburn. In conclusion, symptoms ofheartburn and acid regurgitation become less frequentfollowing admission to hospital. This probably relatesto a reduction in physical exertion following hospital admission but may reflect a reduction inanxiety levels or treatment of underlying disease.Patients on prolonged bed rest and those givennon-steroidal anti-inflammatory drugs are at increasedrisk of refluxlike symptoms and may require antirefluxmeasures.     

Effect of Pneumatic Dilation on Gastroesophageal Reflux in Achalasia

The aims of this study were to assess the effectof pneumatic dilation on gastroesophageal reflux inachalasia, differentiate esophageal acid due to lactatefrom acid due to gastroesophageal reflux, and determine if chest pain and heartburn arereliable indicators of gastroesophageal reflux. Eightuntreated achalasia patients underwent pre- andpostdilation esophageal fluid/food residue lactate andpH analysis, esophageal manometry, 24-hr pHmonitoring, and symptom assessment. All patients had asuccessful clinical outcome and a decrease in loweresophageal sphincter pressure from 29.1 ± 12.7 to14.7 ± 3.8 mm Hg (mean ± SD; P = 0.04). Abnormalacid exposure was present in two patients before and twopatients after dilation. Postdilation acid exposure wasmild. Lactate was detected before dilation in allpatients. A lactate concentration 2 mmol/liter wasassociated with acidic residue and one abnormal 24-hr pHprofile. There was no correlation between an abnormal24-hr pH test and age, lower esophageal sphincter pressure, or duration of symptoms prior totreatment. Chest pain and heartburn were unrelated todrops in pH. Gastroesophageal reflux is rare inuntreated achalasia and esophageal acidity may resultfrom ingestion of acidic foods or production oflactate. Mild gastroesophageal reflux occurs afterdilation but is of no clinical significance. Chest painand heartburn are not indicators of acid reflux inachalasia.     

Gastroesophageal Reflux Disease Is a Common Cause of Noncardiac Chest Pain in a Country with a Low Prevalence of Reflux Esophagitis

Gastroesophageal reflux disease is believed tobe uncommon in the East. This study aimed to determineif such a condition was a significant cause ofnoncardiac chest pain in Singapore. Eighty consecutive patients with recurrent chest pain, who hadcardiac and other obvious causes excluded, underwentesophagogastroduodenoscopy, standard manometry, acidperfusion test, and prolonged ambulatory pH and pressure monitoring. Endoscopic esophagitis, positiveacid perfusion tests, pathologic reflux, and positivechest pain-reflux correlation were detected in 7/80(8.8%), 11/70 (15.7%), 14/61 (23.0%), and 12/25 (48.0%) patients, respectively. Among thosewith pathologic reflux, endoscopic esophagitis waspresent in only two (14.3%). Overall, 32 (40%) patientshad gastroesophageal reflux disease. Esophageal motility disorder, alone or in association withgastroesophageal reflux disease, was demonstrated inonly five (6.3%) patients. Our results confirmed westernreports that gastroesophageal reflux disease was a common cause of noncardiac chest pain,whereas motility disorder was an infrequent cause ofsuch pain.     

Effect of Cyclic Hormonal Changes During Normal Menstrual Cycle on Esophageal Motility

Pregnancy has an inhibitory effect on motilityof the gastrointestinal tract most likely related toincreased levels of circulating female sex hormones.Similar fluctuations of hormones occur during the normal menstrual cycle, but to a much lesserdegree. We studied the effect of these sequentialhormonal changes on esophageal motility and acidexposure by performing an ambulatory esophagealmotility/pH study (AEM/pH) during the follicular (days 2-4)and luteal phases [days 4-8 after the luteinizinghormone (LH) surge] of the menstrual cycle. Ten normalmenstruating women aged 21-39 years, (mean age 31) were studied with a Konigsberg catheterpositioned such that the pH probe was 5 cm above andpressure transducers 7 and 15 cm above the LES.Ovulation was predicted by LH detection kit, and serumprogesterone levels were obtained in the luteal phase. Eachstudy was performed for 16 hr and included meal,upright, and supine periods. Peristaltic contractionsincreased during the meal periods and decreased during supine periods. Simultaneous and isolatedcontractions increased during supine periods anddecreased with meals. Number and amplitude of distalesophageal contractions did not differ significantlybetween follicular and luteal phase during meal,upright and supine periods. Median percentage of time ofdistal esophageal pH < 4 and median acid clearancewere similar between the two phases. In conclusion, esophageal motility and acid exposure, asmeasured by AEM/pH, are not affected by the hormonalchanges that occur during the menstrual cycle.     

Effects of Omeprazole Versus Placebo in Treatment of Noncardiac Chest Pain and Gastroesophageal Reflux

Gastroesophageal reflux (GER) occurs in 22-66%of patients with noncardiac chest pain (NCCP). Althoughopen-label investigations have shown beneficial effectsof antireflux therapy in NCCP, no double-blind, prospective, placebo-controlled studies havebeen conducted. The purpose of this study was toevaluate the effects of omeprazole compared to placeboin a prospective, double-blind, randomized trial ofpatients with NCCP and GER. Thirty-six consecutivepatients with NCCP and GER documented by 24-hrambulatory pH testing entered this study. The subjectswere randomized to omeprazole, 20 mg by mouth twice aday (17 patients), or placebo (19 patients) foreight weeks. Patients on omeprazole obtainedsignificantly more improvement in the fraction of chestpain days (P = 0.006) and severity (P = 0.032) whencompared to placebo. More patients in the omeprazolegroup reported improvement in individual daily painscores (81% vs 44%, P = 0.03) and individual severityscores (81% vs 50%, P = 0.057). Thirteen (81%) of the subjects in the treatment arm reported overallsymptomatic improvement versus one (6%) in the placebogroup (P = 0.001). The results of this study indicatethat acid suppression with omeprazole effectively improves chest pain in patients with NCCP andGER.     

Gastroesophageal Reflux in Achalasia (When Is Reflux Really Reflux?)

An abnormal score during 24-hr esophageal pHmonitoring in achalasia may be associated either with aslow steady drift to below pH 4, or else multiple sharpdips characteristic of typical gastroesophageal reflux. To test the hypothesis that the formerpattern was due to food fermentation and not reflux,samples of chewed bland food (N = 22) were incubatedwith saliva at 37°C for 24 hr and the pH monitored (in vitro study). Further, the pH tracings of20 patients with achalasia before operation and 12patients after operation were studied (in vivo study).The pH of chewed food fell to a median of pH 4.0 during incubation and in seven of 22 samplesfell to below pH 4. Preoperatively, four of the fivepatients with an abnormal pH score showed a slow steadydrift, and all of these had evidence of retained food at endoscopy. Postoperatively, three ofthe six patients with an abnormal pH score had a slowsteady drift to below pH 4. Use of pH 3 as a thresholdclearly distinguished true reflux from foodfermentation, since the patients with reflux all had anabnormal percentage of time below pH 3.     

Prevalence and Impact of Symptoms Suggestive of Gastroesophageal Reflux Disease

Few studies have focused on the impact ofgastroesophageal reflux disease on general health and onwork absenteeism. Our aim was to evaluate the prevalenceand severity of symptoms suggestive of gastroesophageal reflux disease in two samples of Italianemployees. We interviewed 424 subjects of S. MatteoHospital staff and 344 subjects of the Military Factoryof Pavia regarding the frequency and severity ofheartburn and acid regurgitation during the last 12months. Subjects were specifically asked whethersymptoms interfered with the quality of work activitiesor determined work absenteeism. In all, 91% of eligible subjects responded. The prevalence rate per 100of any heartburn or regurgitation experienced at leastmonthly was 21. This value increased to 45% taking intoconsideration symptoms experienced occasionally. Mild or moderate symptoms were more frequentthan severe symptoms (P < 0.001). Only 2.6% ofsubjects answered that symptoms have a negativeinfluence on the quality of their work. No workabsenteeism was recorded. The study confirms that typicalgastroesophageal reflux symptoms are common conditions,but mainly of mild or moderate degree.     

Effects of Red Wine on 24-Hour Esophageal pH and Pressures in Healthy Volunteers

The purpose of this study was to assess theeffects of red wine taken with meals on esophagealmotility, esophageal exposure to acid, and gastric pH.Following a randomized design, 14 healthy malevolunteers (mean age 25 years, range 18 -35 years weregiven 360 ml of red wine or tap water during lunch ordinner. All subjects underwent ambulatory 24-hresophageal motility and esophagogastric pH monitoringstudies. Three different periods were analyzed: duringmeals (30 min), postprandial (3 hr), and 8-hr supine.Two volunteers complained of heartburn after wineingestion. An increase in the number of high amplitude waves (>125 mm Hg, 95th percentile of ourmotility unit controls) was observed during mealsaccompanied by wine: water 1.2 (0-10.2), wine 1.6(0-32.6), P = 0.02 [median (range)]. No other esophagealmotility changes occurred. Percent reflux time increasedduring the postprandial period after wine ingestion incomparison with water: 1.7 (0-14.9) vs 0.1 (0- 0.8), P< 0.05. Gastric pH was unaffected by the type of drink. Ingestion of moderate amounts of redwine with meals increases postprandial esophagealexposure to gastric acid in healthy persons.     

Identification of Diaphragmatic Crural Component of Gastroesophageal Barrier in the Rat

Manometric assessment of the diaphragmaticcontribution to the human gastroesophageal barrier isdifficult because it overlaps with that of the loweresophageal sphincter. Our aim was to investigate the barrier components in the rat in which thegastroesophageal junction is widely separated from thehiatus. Rats under anesthesia (N = 119) and after musclerelaxation (N = 14) underwent stationary andpull-through perfusion manometry. Inspiratorytransdiaphragmatic pressure gradient was 5.79 ±1.69 mm Hg and lower esophageal sphincter pressure was14.76 ± 8.63 mm Hg. A 13.78 ± 3.13-mmintraabdominal segment of the esophagus was interposed craniallybetween the sphincter and a group of phasic oscillationswith frequency identical to the respiratory rate andpressure of 13.81 ± 6.54 mm Hg, which disappeared after muscle relaxation. Both components of thegastroesophageal barrier in the rat are widely separatedby a long intraabdominal esophagus. This arrangementallows investigation of the behavior of both components under challengingconditions.