Transient lower esophageal sphincter relaxations and esophageal body muscular contractile response in reflux esophagitis

In patients with gastroesophageal reflux disease (GERD), transient lower es ophageal sphincter relaxations (TLESRs) are more frequently accompanied by acid reflux than in normals. The role of esophageal tone during gastroesoph ageal reflux events is unknown. We studied the tonic motor activity in the body of the esophagus during TLESRs with and without acid reflux in 11 pati ents with erosive esophagitis and compared the results with those previousl y obtained in healthy subjects. Esophageal peristaltic contractions were re corded 13, 8, and 3 cm above a sleeve that measured LES pressure. An intral uminal balloon was inflated 8 cm above the sleeve to induce an esophageal t onic contraction [artificial high pressure zone (HPZ)]. The percentage of T LESRs with acid reflux was significantly higher in patients with esophagiti s than in healthy controls (58.3% vs 37.3%, P < 0.05). TLESRs per sc were n ot associated with an inhibition or increase in esophageal body contractili ty, which, however, changed substantially immediately after reflux. In pati ents with esophagitis the esophageal body tonic contractility was inhibited in 59.5% of TLESRs vs 36% in controls (P < 0.05). Esophageal contractions during TLESRs traveled down the esophagus in 77% of the instances in patien ts vs 96.5% in controls (P < 0.05). In conclusion, gastroesophageal reflux during TLESRs was more frequently associated with inhibition of esophageal body tonic contractility in patients with esophagitis than in normals. The different response of the esophageal body to reflux observed in GERD patien ts may partially contribute to the higher prevalence of reflux during TLESR s in these patients.