title: Gastric emptying: a contributory factor in gastro-oesophageal reflux activity?
abstract: OBJECTIVE
  To evaluate the impact of total and proximal stomach emptying on 24 hour and postprandial reflux as well as the number of reflux episodes per hour in relation to the impact of lower oesophageal sphincter (LOS) pressure, and oesophageal contractile and clearance function.
  
  
  METHODS
  Seventy one outpatients (37 female, 34 male; age 23-82 years) with symptoms suggestive of both delayed gastric emptying and reflux referred for further investigations participated in the study. Gastric emptying of a semisolid 1168 kJ meal and oesophageal clearance of a water bolus (supine) were recorded scintigraphically, reflux by 24 hour pH monitoring, and oesophageal motility manometrically.
  
  
  RESULTS
  Slow proximal but not slow distal or total stomach emptying correlated with increased 24 hour and postprandial acid exposure and increased number of reflux episodes/hour. No relationship was found between total or proximal emptying and LOS resting pressure, oesophageal contraction amplitude, percentage of failed contractions, or clearance. Multiple linear regression analyses showed that slow proximal emptying and low LOS pressure contributed significantly to both 24 hour (p=0.0007 and p=0. 0001) and two hour postprandial acid exposure (p=0.007 and p=0.0001). In contrast, the rate of total emptying contributed to neither 24 hour nor postprandial acid exposure.
  
  
  CONCLUSIONS
  Our data suggest that in contrast with total stomach emptying, the rate of proximal stomach emptying contributes to the extent of 24 hour as well as postprandial acid exposure and the number of reflux episodes/hour.
authors.affiliation: Psychophysiology Unit, Department of Surgery, University of Vienna, Vienna, Austria. georg.stacher@akh-wien@ac.at
authors.forename: G
authors.initials: G
authors.lastname: Stacher
authors.forename: J
authors.initials: J
authors.lastname: Lenglinger
authors.forename: H
authors.initials: H
authors.lastname: Bergmann
authors.forename: C
authors.initials: C
authors.lastname: Schneider
authors.forename: M
authors.initials: M
authors.lastname: Hoffmann
authors.forename: G
authors.initials: G
authors.lastname: Wölfl
authors.forename: G
authors.initials: G
authors.lastname: Stacher-Janotta
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D005260:Female; D005746:Gastric Emptying / Q000502:physiology*; D005764:Gastroesophageal Reflux / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008365:Manometry; D008875:Middle Aged; D019518:Postprandial Period; D011877:Radionuclide Imaging; D012044:Regression Analysis