Colonic fermentation influences lower esophageal sphincter function in gastroesophageal reflux disease.
OBJECTIVE
Colonic fermentation of carbohydrates is known to influence gastric and esophageal motility in healthy subjects. This study investigated the effects of colonic fermentation induced by oral administration of fructooligosaccharides (FOS) in patients with gastroesophageal reflux disease (GERD).


METHODS
In the cross-over design used in the study, 9 patients with symptomatic GERD were administered a low-residue diet (i.e., 10 g fiber/day) during 2, 7-day periods, receiving either 6.6 g of FOS or placebo 3 times daily after meals. Each period was separated by a wash out of at least 3 weeks. On day 7, esophageal motility and pH were recorded in fasting conditions and after a test meal containing 6.6 g of FOS or placebo. Breath hydrogen concentrations (reflecting colonic fermentation) and plasma concentrations of glucagon-like peptide 1 (GLP-1), peptide YY, and cholecystokinin were monitored.


RESULTS
Compared with placebo, FOS led to a significant increase in the number of transient lower esophageal sphincter relaxations (TLESRs) and reflux episodes, esophageal acid exposure, and the symptom score for GERD. The integrated plasma response of GLP-1 was significantly higher after FOS than placebo.


CONCLUSIONS
Colonic fermentation of indigestible carbohydrates increases the rate of TLESRs, the number of acid reflux episodes, and the symptoms of GERD. Although different mechanisms are likely to be involved, excess release of GLP-1 may account, at least in part, for these effects.
Piche
Thierry
T
CIC INSERM and U 539-Centre Hospitalier Universitaire-Hôtel Dieu, Nantes, France.
des Varannes
Stanislas Bruley
SB
Sacher-Huvelin
Sylvie
S
Holst
Jens Juul
JJ
Cuber
Jean Claude
JC
Galmiche
Jean Paul
JP
D000284:Administration, Oral; D000328:Adult; D001944:Breath Tests; D002766:Cholecystokinin / Q000097:blood; D003106:Colon / Q000378:metabolism*; D018592:Cross-Over Studies; D004032:Diet; D004943:Esophagogastric Junction / Q000502:physiology*; D005260:Female; D005285:Fermentation; D005764:Gastroesophageal Reflux / Q000378:metabolism* / Q000503:physiopathology*; D005934:Glucagon / Q000097:blood; D052216:Glucagon-Like Peptide 1; D006801:Humans; D006859:Hydrogen / Q000032:analysis; D008297:Male; D008875:Middle Aged; D009844:Oligosaccharides / Q000493:pharmacokinetics; D010349:Patient Compliance; D010446:Peptide Fragments / Q000097:blood; D019894:Peptide YY / Q000097:blood; D019518:Postprandial Period / Q000187:drug effects; D011498:Protein Precursors / Q000097:blood
D009844:Oligosaccharides; D010446:Peptide Fragments; D011498:Protein Precursors; C116580:fructooligosaccharide; D019894:Peptide YY; D006859:Hydrogen; D052216:Glucagon-Like Peptide 1; D005934:Glucagon; D002766:Cholecystokinin