Swallows, oesophageal and gastric motility in normal subjects and in patients with gastro-oesophageal reflux disease: a 24-h pH-manometric study.

ABSTRACT

BACKGROUND: the motor aspects underlying gastro-oesophageal reflux disease (GORD) are still not completely clear. AIM: to evaluate the relationship between oesophageal and gastric motility in GORD patients. PATIENTS twelve patients with grade I-II oesophagitis, mean age 45 yr, and 10 healthy subjects, mean age 42 yr, were studied. METHODS: a pH-manometry was performed to analyse oesophageal and gastric motility, swallows and oesophageal pH values for the whole 24-h period, and for the 2-min period before and after each reflux episode. RESULTS: as compared to controls, GORD patients showed in the 24-h period, a greater number of swallows (P < 0.01) and a lower percentage of post deglutitive propagated oesophageal body waves (P < 0.05). The number of migrating motor complexes (MMC) was similar in the two groups, with a lower amplitude of phase III gastric waves in GORD. During MMC reflux episodes were seen only in GORD patients. After refluxes an increase in swallows, simultaneous and secondary oesophageal waves were detected in GORD patients, with a reduction of primary peristalsis. Isolated gastric contractions preceded reflux episodes more frequently in GORD patients than in controls. CONCLUSIONS: GORD patients showed an increase in swallows with altered post-deglutitive oesophageal motility and a reduced amplitude of gastric MMC. Moreover small contractions of gastric antrum are present before acid refluxes, suggesting a multifactorial pathogenesis of the disease.