Regulation of transient lower esophageal sphincter relaxation in the pathogenesis of gastroesophageal reflux disease


Authors: M. Ďuriček;  M. Schnierer
Authors‘ workplace: Interná klinika gastroenterologická JLF UK a UN Martin, Slovenská republika
Published in: Gastroent Hepatol 2016; 70(4): 305-309
Category: Clinical and Experimental Gastroenterology: Review Article
doi: 10.14735/amgh2016csgh.info09

Overview

Transient lower esophageal sphincter relaxation (TLESR) is a reflexive process allowing swallowed air to be released from the stomach. At the same time, it is also one of the mechanisms participating in the emergence of gastroesophageal reflux. TLESR regulation in humans has been well studied, but there is little information so far on the influence of esophageal stimuli on TLESR development. If TLESR regulation by esophageal stimulation exists, then it is likley to be mediated by afferent esophageal neurons, whose stimulation by refluxate components (e. g. acid) can lead to TLESR dysregulation. The authors are contemplating, within the context of recently published work, the importance of TLESR dysregulation in the pathogenesis of gastroesophageal reflux disease.

Key words:
gastroesophageal reflux – esophagus – transient lower esophageal sphincter relaxation – acid

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

Submitted:
19. 8. 2015

 Accepted:
10. 11. 2015


Sources

1. Mittal RK, Hol­loway RH, Penagini R et al. Transient lower esophageal sphincter relaxation. Gastroenterology 1995; 109(2): 601– 610.

2. Orlando RC. Pathophysiology of gastroesophageal reflux disease. J Clin Gastroenterol 2008; 42(5): 584– 588. doi: 10.1097/ MCG.0b013e31815d0628.

3. Smith JL, Opekun AR, Larkai E et al. Sensitivity of the esophageal mucosa to pH in gastroesophageal reflux disease. Gastroenterology 1989; 96(3): 683– 689.

4. Boeckxstaens GE. Alterations confined to the gastro-oesophageal junction: the relationship between low LOSP, TLOSRs, hiatus hernia and acid pocket. Best Pract Res Clin Gastroenterol 2010; 24(6): 821– 829. doi: 10.1016/ j.bpg.2010.08.011.

5. Sifrim D, Hol­loway R. Transient lower esophageal sphincter relaxations: how many or how harmful? Am J Gastroenterol 2001; 96(9): 2529– 2532.

6. Lidums I, Lehmann A, Checklin H. Control of transient lower esophageal sphincter relaxations and reflux by the GABA(B) agonist baclofen in normal subjects. Gastroenterology 2000; 118(1): 7– 13.

7. Boeckxstaens GE, Rydholm H, Lei A et al. Ef­fect of lesogaberan, a novel GABA-(B)-receptor agonist, on transient lower oesophageal sphincter relaxations in male subjects. Aliment Pharmacol Ther 2010; 31(11): 1208– 1217. doi: 10.1111/ j.1365-2036. 2010.04283.x.

8. Kahrilas PJ, Shi G, Manka M et al. In­creased frequency of transient lower esophageal sphincter relaxation induced by gastric distention in reflux patients with hiatal hernia. Gastroenterology 2000; 118(4): 688– 695.

9. Penagini R, Bianchi PA. Ef­fect of morphine on gastroesophageal reflux and transient lower esophageal sphincter relaxation. Gastroenterology 1997; 113(2): 409– 414.

10. Sifrim D, Hol­loway R, Silny J et al. Composition of the postprandial refluxate in patients with gastroesophageal reflux dis­ease. Am J Gastroenterol 2001; 96(3): 647– 655.

11. Banovcin P Jr, Halicka J, Halickova M et al. Studies on the regulation of transient lower esophageal sphincter relaxations (TLESRs) by acid in the esophagus and stomach. Dis Esophagus 2016; 29(5): 484–489. doi: 10.1111/ dote.12357.

12. Halicka J, Banovcin P Jr, Halickova Met al. Acid infusion into the esophagus increases the number of meal-induced transient lower esophageal sphincter relaxations (TLESRs) in healthy volunteers. Neurogastroenterol Motil 2014; 26(10): 1469– 1476. doi: 10.1111/ nmo.12409.

13. Page AJ, Blackshaw LA. Roles of gastro-oesophageal af­ferents in the mechanisms and symp­toms of reflux disease. Handb Exp Pharmacol 2009; 194(1): 227– 257. doi: 10.1007/ 978-3-540-79090-7_7.

14. Kol­larik M, Ru F, Brozmanova M. Vagal af­ferent nerves with the properties of nociceptors. Auton Neurosci 2010; 153(1– 2): 12– 20. doi: 10.1016/ j.autneu.2009.08.001.

15. Roman S, Zerbib F, Belhocine K et al. High resolution manometry to detect transient lower oesophageal sphincter relaxations: dia­gnostic accuracy compared with perfused-sleeve manometry, and the definition of new detection criteria. Aliment Pharmacol Ther 2011; 34(3): 384– 393. doi: 10.1111/j.1365-2036.2011.04728.x.

16. Ďuriček M, Bánovčin P, Hyrdel R. Poruchy motility pažeráka –  Chicagska klasifikácia, v3.0. Gastroent Hepatol 2015; 69(2): 130– 138. doi: 10.14735/ amgh2015130.

17. Hol­loway RH, Boeckxstaens GE, Penagini R et al. Objective definition and detection of transient lower esophageal sphincter relaxation revisited: is there room for improvement? Neurogastroenterol Motil 2012; 24(1): 54– 60. doi: 10.1111/ j.1365-2982.2011.01812.x.

18. Ru F, Banovcin P Jr, Kol­larik M. Acid sensitivity of the spinal dorsal root ganglia C-fiber nociceptors in­nervat­ing the guinea pig esophagus. Neurogastroenterol Motil 2015; 27(6): 865– 874. doi: 10.1111/ nmo.12561.

19. Dusenkova S, Ru F, Surdenikova L et al. The expres­sion profile of acid-sen­s­­ing ion chan­nel (ASIC) subunits ASIC1a, ASIC1b, ASIC2a, ASIC2b, and ASIC3 in the esophageal vagal af­ferent nerve subtypes. Am J Physiol Gastrointest Liver Physiol 2014; 307(9): G922– G930. doi: 10.1152/ ajpgi.00129.2014.

20. Matthews PJ, Knowles CH, Chua YC et al. Ef­fects of the concentration and frequency of acid infusion on the development and maintenance of esophageal hyperalgesia in a human volunteer model. Am J Physiol Gastrointest Liver Physiol 2008; 294(4): G914–G917.

21. Bredenoord A. Management of belch­ing, hiccups, and aerophagia. Clin Gastroenterol Hepatol 2013; 11(1): 6– 12. doi: 10.1016/ j.cgh.2012.09.006.

22. Cos­sentino MJ, Mann K, Armbruster SP et al. Randomised clinical trial: the ef­fect of baclofen in patients with gastro-oesophageal reflux –  a random­ised prospective study. Aliment Pharmacol Ther 2012; 35(9): 1036– 1044. doi: 10.1111/ j.1365-2036.2012.05068.x.

Labels
Paediatric gastroenterology Gastroenterology and hepatology Surgery

Article was published in

Gastroenterology and Hepatology

Issue 4

2016 Issue 4

Most read in this issue

This topic is also in:


Login
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account