Gastric emptying: a contributory factor in gastro-oesophageal reflux activity?

Aims-To evaluate the impact of total and proximal stomach emptying on 24 ho ur and postprandial reflux as well as the number of reflux episodes per hou r in relation to the impact of lower oesophageal sphincter (LOS) pressure, and oesophageal contractile and clearance function. Methods-Seventy one outpatients (37 female, 34 male; age 23-82 years) with symptoms suggestive of both delayed gastric emptying and reflux referred fo r further investigations participated in the study. Gastric emptying of a s emisolid 1168 kJ meal and oesophageal clearance of a water bolus (supine) w ere recorded scintigraphically, reflux by 24 hour pH monitoring, and oesoph ageal motility manometrically. Results-Slow proximal but not slow distal or total stomach emptying correla ted with increased 24 hour and postprandial acid exposure and increased num ber of reflux episodes/hour. No relationship was found between total or pro ximal emptying and LOS resting pressure, oesophageal contraction amplitude, percentage of failed contractions, or clearance. Multiple linear regressio n analyses showed that slow proximal emptying and low LOS pressure contribu ted significantly to both 24 hour (p=0.0007 and p=0.0001) and two hour post prandial acid exposure (p=0.007 and p=0.0001). In contrast, the rate of tot al emptying contributed to neither 24 hour nor postprandial acid exposure. Conclusion-Our data suggest that in contrast with total stomach emptying, t he rate of proximal stomach emptying contributes to the extent of 24 hour a s well as postprandial acid exposure and the number of reflux episodes/hour .