title: Studies on the regulation of transient lower esophageal sphincter relaxations (TLESRs) by acid in the esophagus and stomach.
abstract: Transient lower esophageal sphincter relaxation (TLESR) is the major mechanism of gastroesophageal reflux, but the regulation of TLESR by stimuli in the esophagus is incompletely understood. We have recently reported that acid infusion in the esophagus substantially (by 75%) increased the number of meal-induced TLESR in healthy subjects. We concluded that the TLESR reflex triggered by gastric distention with meal was enhanced by the stimulation of esophageal nerves by acid. However, the possibilities that the acid infused into the esophagus acts after passing though lower esophageal sphincter in stomach to enhance TLESR, or that the acid directly initiates TLESR from the esophagus were not addressed. Here, we evaluated the effect of acid infusion into the proximal stomach on meal-induced TLESR (study 1) and the ability of acid infusion into the esophagus to initiate TLESR without prior meal (study 2). We analyzed TLESRs by using high-resolution manometry in healthy subjects in paired randomized studies. In study 1, we found that acid infusion into the proximal stomach did not affect TLESRs induced by standard meal. The number of meal-induced TLESRs following the acid infusion into the proximal stomach was similar to the number of meal-induced TLESRs following the control infusion. In study 2, we found that acid infusion into the esophagus without prior meal did not initiate TLESRs. We conclude that the increase in the meal-induced TLESRs by acid in the esophagus demonstrated in our previous study is not attributable to the action of acid in the stomach or to direct initiation of TLESR from the esophagus by acid. Our studies are consistent with the concept that the stimuli in the esophagus can influence TLESRs. The enhancement of TLESR by acid in the esophagus may contribute to pathogenesis of gastroesophageal reflux in some patients.
authors: Department of Pathophysiology, Jessenius Faculty of Medicine in Martin, Comenius University, Bratislava, Slovakia.|Department of Gastroenterology, Jessenius Faculty of Medicine in Martin, Comenius University, Bratislava, Slovakia.
authors: P
authors: P
authors: Banovcin
authors: Department of Pathophysiology, Jessenius Faculty of Medicine in Martin, Comenius University, Bratislava, Slovakia.
authors: J
authors: J
authors: Halicka
authors: Department of Pathophysiology, Jessenius Faculty of Medicine in Martin, Comenius University, Bratislava, Slovakia.
authors: M
authors: M
authors: Halickova
authors: Department of Gastroenterology, Jessenius Faculty of Medicine in Martin, Comenius University, Bratislava, Slovakia.
authors: M
authors: M
authors: Duricek
authors: Department of Gastroenterology, Jessenius Faculty of Medicine in Martin, Comenius University, Bratislava, Slovakia.
authors: R
authors: R
authors: Hyrdel
authors: Department of Pathophysiology, Jessenius Faculty of Medicine in Martin, Comenius University, Bratislava, Slovakia.
authors: M
authors: M
authors: Tatar
authors: Department of Pathophysiology, Jessenius Faculty of Medicine in Martin, Comenius University, Bratislava, Slovakia.|Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors: M
authors: M
authors: Kollarik
mesh_terms: D000143:Acids / Q000494:pharmacology*; D000328:Adult; D049630:Esophageal Sphincter, Lower / Q000502:physiology*; D004947:Esophagus / Q000502:physiology; D005260:Female; D005764:Gastroesophageal Reflux / Q000503:physiopathology; D064368:Healthy Volunteers; D006801:Humans; D008297:Male; D008365:Manometry; D062407:Meals; D009126:Muscle Relaxation / Q000187:drug effects*; D019518:Postprandial Period / Q000187:drug effects* / Q000502:physiology; D011897:Random Allocation; D016037:Single-Blind Method; D013270:Stomach / Q000502:physiology; D055815:Young Adult
chemical_list: D000143:Acids
keywords: acid; esophagus; gastroesophageal reflux; stomach; transient lower esophageal sphincter relaxation; vagus nerve