Preservation of postural control of transient lower oesophageal sphincter relaxations in patients with reflux oesophagitis

Abstract

Introduction—In normal subjects, transient lower oesophageal sphincter relaxations (TLOSRs) and gas reflux during belching are suppressed in the supine position. Supine reflux, however, is a feature of reflux disease. Aims—To investigate whether postural suppression of TLOSRs and gas reflux is impaired in patients with reflux disease. Patients—Ten patients with erosive oesophagitis. Methods—Oesophageal manometry was performed during gastric distension with 750 ml carbon dioxide. Measurements were made for 10 minutes before and after distension in both sitting and supine positions. Results—In the sitting position gastric distension substantially increased the rate of gas reflux (median (interquartile range)), as evidenced by increases in oesophageal common cavities from 1 (0–1)/10 min to 7 (5–10)/10 min and TLOSRs from 1 (1–1.5)/10 min to 6 (2.5–8)/10 min. However, this effect was suppressed in the supine position in all but one patient (TLOSRs 0 (0)/10 min to 1 (0–4.5)/10 min, common cavities 0 (0)/10 min to 0.5 (0–2)/10 min). Conclusions—Postural suppression of TLOSRs and gas reflux is generally preserved in reflux disease.