Transient lower oesophageal sphincter relaxations play an insignificant role in gastro-oesophageal reflux to the proximal oesophagus

Gastro-oesophageal reflux to the proximal oesophagus may cause atypical sym ptoms of gastro-oesophageal reflux disease (GORD). The motor abnormalities underlying reflux into the proximal oesophagus are still unclear. The aim o f this study was to analyse the oesophageal motility during reflux into the proximal oesophagus in a group of healthy subjects and in patients with at ypical symptoms of GORD. We concentrated particularly on lower oesophageal sphincter (LOS) activity and transient lower oesophageal sphincter relaxati ons (TLOSRs). Ten patients (7M, 3F, age 25-51 years) with mild oesophagitis (Savary-Miller grade I-II) and 10 healthy subjects (6M, 4F, age 23-54 year s) underwent a 24-h dual pH-metric and manometric recording, using an elect ronic portable device. This recorded distal and proximal oesophageal pH val ues, oesophageal body and LOS motility. GORD patients had more distal and p roximal reflux (DR and PR) compared with healthy controls (DR P < 0.001; PR P < 0.05). TLOSRs were the most frequent event during reflux into the dist al oesophagus, whereas TLOSR frequency was much lower during reflux to the proximal oesophagus in GORD patients and in healthy controls (P < 0.05 and P < 0.01 vs. distal reflux, respectively). A significant relationship betwe en TLOSRs and distal refluxes was present but no relationship with proximal reflux was detected. We conclude that TLOSRs are much less frequent during reflux to the proximal oesophagus than distal oesophageal reflux in patien ts with mild GORD suffering from atypical manifestations. The mechanism of acid reflux to the proximal oesophagus is unclear.