Service d”Hépato-Gastroentérologie et Alcoologie, Hôpital Caremeau, Centre Hospitalier et Universitaire de Nı̂mes, 30900 France; and
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During swallowing, complete LES relaxation was observed in 99% of iterations, whereas HPZ relaxation occurred in 80%. Relaxation was complete (pressure drop >80% of the baseline value) in 59% of HPZ relaxations (Fig. 1). HPZ relaxation occurred 0.6 ± 0.5 s before that of the LES, had a shorter duration (5.2 ± 0.7 vs. 7.5 ± 0.5 s, PFig. 1.Relaxation of the lower esophageal sphincter (LES) and the high-pressure zone (HPZ) during primary peristalsis. The HPZ was obtained between an inflated latex balloon and the esophageal (Eso) wall 8 cm above the LES. Swallow is indicated by the pharyngeal (Phar) contraction (arrow). Relaxation of the HPZ was complete, occurred before LES relaxation, and terminated with primary peristalsis.
During pharyngeal stimulation, LES relaxation occurred in 63% of trials (Fig. 2). The interval between the onset of pharyngeal stimulation and LES relaxation was 4.6 ± 0.8 s and the duration of relaxation was 20.8 ± 4.3 s, significantly longer than swallow-induced relaxations (7.5 ± 0.5 s, P 1) spontaneous return of LES pressure to baseline,2) primary peristalsis, or 3) simultaneous esophageal contraction (Table 1). No HPZ relaxation was observed during pharyngeal stimulation, and no acid reflux or common cavity events were observed.
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Fig. 2.LES relaxation induced by pharyngeal stimulation illustrated with the same recording setup as in Fig. 1. Rapid injection of water (arrow) 2 cm above the upper esophageal sphincter (UES) is followed by LES relaxation lasting 18 s. Relaxation is complete, shown by nadir pressure relative to the stomach being ≤4 mmHg. Pharyngeal stimulation is not associated with relaxation of the HPZ.
During gastric distension studies 117 episodes of spontaneous LES relaxation were recorded, all of which met the criteria for tLESRs (5) with a mean duration of 23 ± 4 s. Among these, 56 were associated with acid reflux, always in association with a common cavity. Gas reflux events, defined by the occurrence of a common cavity without a concomitant decrease of pH to a value 3 and Table 1). tLESR was not associated with any consistent pattern of HPZ relaxation regardless of the presence or constituents of the refluxate. During tLESRs, the mean pressure variation in the HPZ was 2.6 ± 1 mmHg (tLESR without reflux) 5 ± 0.8 mmHg (tLESR + acid reflux), and 4.9 ± 0.8 mmHg (tLESR + gas reflux) (PFig. 3.
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Transient LES relaxation associated with acid reflux. LES relaxation (arrow) is associated with a drop of intraluminal pH, consistent with acid reflux. Pressure in the HPZ persists unchanged during the 22 s of LES relaxation. LES relaxation terminates with secondary peristalsis associated with HPZ relaxation.