title: Impaired upper esophageal sphincter reflexes in patients with supraesophageal reflux disease.
abstract: OBJECTIVE
  Normal responses of the upper esophageal sphincter (UES) and esophageal body to liquid reflux events prevent esophagopharyngeal reflux and its complications, however, abnormal responses have not been characterized. We investigated whether patients with supraesophageal reflux disease (SERD) have impaired UES and esophageal body responses to simulated reflux events.
  
  
  METHODS
  We performed a prospective study of 25 patients with SERD (age, 19-82 y; 13 women) and complaints of regurgitation and supraesophageal manifestations of reflux. We also included 10 patients with gastroesophageal reflux disease (GERD; age, 32-60 y; 7 women) without troublesome regurgitation and supraesophageal symptoms and 24 healthy asymptomatic individuals (controls: age, 19-49 y; 13 women). UES and esophageal body pressure responses, along with luminal distribution of infusate during esophageal rapid and slow infusion of air or liquid, were monitored by concurrent high-resolution manometry and intraluminal impedance.
  
  
  RESULTS
  A significantly smaller proportion of patients with SERD had UES contractile reflexes in response to slow esophageal infusion of acid than controls or patients with GERD. Only patients with SERD had abnormal UES relaxation responses to rapid distension with saline. Diminished esophageal peristaltic contractions resulted in esophageal stasis in patients with GERD or SERD.
  
  
  CONCLUSIONS
  Patients with SERD and complaints of regurgitation have impaired UES and esophageal responses to simulated liquid reflux events. These patterns could predispose them to esophagopharyngeal reflux.
authors.affiliation: Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Arash
authors.initials: A
authors.lastname: Babaei
authors.affiliation: Division of Gastroenterology & Hepatology, Loyola University Medical Center, Chicago, IL.
authors.forename: Mukund
authors.initials: M
authors.lastname: Venu
authors.affiliation: Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Sohrab Rahimi
authors.initials: SR
authors.lastname: Naini
authors.affiliation: Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Jason
authors.initials: J
authors.lastname: Gonzaga
authors.affiliation: Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Ivan M
authors.initials: IM
authors.lastname: Lang
authors.affiliation: Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Benson T
authors.initials: BT
authors.lastname: Massey
authors.affiliation: Divisions of Neonatology, Pediatric Gastroenterology and Nutrition, The Research Institute at Nationwide Children's Hospital, Columbus, OH.
authors.forename: Sudarshan
authors.initials: S
authors.lastname: Jadcherla
authors.affiliation: Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin. Electronic address: rshaker@mcw.edu.
authors.forename: Reza
authors.initials: R
authors.lastname: Shaker
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000388:Air; D017097:Electric Impedance; D049631:Esophageal Sphincter, Upper / Q000502:physiology* / Q000503:physiopathology; D005260:Female; D005764:Gastroesophageal Reflux / Q000503:physiopathology*; D006801:Humans; D057045:Laryngopharyngeal Reflux / Q000503:physiopathology; D008297:Male; D008365:Manometry / Q000379:methods; D008875:Middle Aged; D009119:Muscle Contraction / Q000502:physiology*; D010528:Peristalsis / Q000502:physiology*; D011446:Prospective Studies; D012018:Reflex / Q000502:physiology*; D014867:Water; D055815:Young Adult
chemical_list: D014867:Water
keywords: Cervical; EUCR; EURR; Extraesophageal Reflux; Laryngopharyngeal Reflux; Striated Esophagus