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 22 May 2018

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News

Transient lower esophageal sphincter relaxations no more frequent in GERD

Transient lower esophageal sphincter relaxations are no more frequent in GERD patients than matched asymptomatic controls, although, when they do occur, they are twice as likely to be associated with acid reflux, claims a team from Sheffield, England.

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The researchers studied the frequency of transient lower esophageal sphincter relaxations (TLESRs) in patients with gastroesophageal reflux disease (GERD). They also looked at the frequency and mechanisms of acid reflux episodes in these subjects.

The findings of the investigation were published in the September issue of the American Journal of Gastroenterology.

Some 10 symptomatic GERD patients (4 male; mean age, 50 years) and 10 asymptomatic matched controls (4 male; mean age 50 years) were studied.

Esophageal, lower esophageal sphincter, and gastric manometric, as well as esophageal pH readings were recorded. These were conducted for 1 hour before, and 1 hour after, a 200 kcal, 150 ml long-chain triglyceride meal.

TLESR frequency increased after the meal, in both controls (median 0 to 3 per hour) and patients (1 to 2.5 per hour).

TLESRs twice as likely to be associated with acid reflux in GERD patients.
American Journal of Gastroenterology

There was no significant difference in the frequency of TLESRs between controls and patients.

The researchers found that TLESRs were more likely to be associated with acid reflux in patients (65% vs 37%). Controls were found to be more likely to reflux gas or liquid without acid (30% vs 3%).

Author N. J. Trudgill, of the Northern General Hospital, Sheffield, concludes on behalf of the group, "TLESRs are no more frequent in patients with GERD than age- and sex-matched asymptomatic volunteers.

"However, when TLESRs occur in patients, they are twice as likely to be associated with acid reflux."

This suggests that factors other than the frequency of TLESRs are important in the pathogenesis of GERD, and that treatment strategies based solely on a reduction in TLESR frequency may have a limited impact.

In an accompanying editorial, Daniel Sifrim and Richard Holloway write that this research challenges the belief that reflux disease is due to a disordered control of triggering of TLESRs.

The major abnormality appears to be in the occurrence of acid reflux during TLESRs, they add.

This does not undermine the concept that TLESRs are a major mechanism of reflux, but instead puts it into sharper focus, they conclude.

Am J Gastroenterol 2001; 96(9): 2569-74
17 October 2001

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