It has been shown that gastro-esophageal reflux plays a role in the pathogenesis of intestinal metaplasia (IM) limited to the esophagogastric junction (EGJ), similar to the pathogenesis of IM in long segments of columnar lined esophagus.
Now a study has examined lower esophageal sphincter (LES) function, by means of prolonged recording, in patients with IM limited to a normal appearing EGJ.
Conventional stationary esophageal manometry was undertaken on 18 patients with IM at the EGJ (5 females and 13 males, mean age 55.4 years), and 22 patients without IM (9 females and 13 males, mean age 53.9 years).
This was followed by 7 hour water-perfused manometry with simultaneous pH measurement (probe 5 cm proximal to the LES).
Swallowing was monitored with a pharyngeal sidehole and LES pressure was recorded with a Dent sleeve.
Patients were studied in the fasted state (3 hours) and after a standardized meal (4 hours).
LES pressure was analyzed using customized software, and the incidence of reflux episodes (pH less than 4 for at least 5 seconds) and transient LES relaxations (TLESRs) were examined.
A TLESR was judged to be accompanied by reflux if a decrease of 1 pH unit occurred during relaxation.
| Patients with IM at the EGJ had more postprandial acid reflux|
Patients with IM at the EGJ had a higher prevalence of postprandial acid reflux compared with patients without IM.
No differences were observed in LES pressure (pre- and postprandial) or in the prevalence of TLESRs.
However, in the postprandial phase, the rate of TLESRs accompanied by acid reflux was increased in patients.
C. Wolf, one of the report authors, said the study showed that patients with IM at the EGJ have a higher prevalence of postprandial acid reflux.
He added that "this was not associated with a higher prevalence of TLESRs or a decreased LES pressure, but with a higher rate of TLESRs accompanied by reflux."