Skip to main content
SpringerLink
Log in

Esophageal Acid Exposure in Upright and Recumbent Postures: Roles of Lower Esophageal Sphincter, Esophageal Contractile and Transport Function, Hiatal Hernia, Age, Sex, and Body Mass

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

This study aimed to assess, using multiple regression analyses, the roles of lower esophageal sphincter, esophageal contractile and transport function, hiatal hernia, age, sex, and body mass for esophageal acid exposure in upright and recumbent postures and for esophagitis. In 116 patients with reflux symptoms, acid exposure was recorded by 24-hr pH monitoring, motility manometrically, bolus transport scintigraphically, hiatal hernia and esophagitis endoscopically. In upright posture, the percentage time at pH <4 increased significantly with higher body mass index and lower distal esophageal amplitude, the number of episodes >5 min at pH <4 with lower distal amplitude, slower transport, and higher body mass, and the longest episode at pH <4 with lower distal amplitude. In recumbency, the percentage time at pH <4 increased with lower percentage of effective esophageal contraction waves and male sex, and the number of episodes and the longest episode with lower percentage effective waves. The severity of esophagitis augmented with slower supine transport and male sex. In both postures, acid exposure and esophagitis seem to be determined primarily by impaired esophageal motility and the ensuing slow bolus transport rather than by compromised lower esophageal sphincter function and the presence and size of a hiatal hernia.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Johnsson F, Joelsson B, Gudmundsson K (1989) Determinants of gastro-oesophageal reflux and their inter-relationships. Br J Surg 76:241–244

    PubMed  CAS  Google Scholar 

  2. Martinez de Haro L, Parilla P, Ortiz A, Morales G, Cifuentes J, Perez D, Videla D (1993) Correlation between esophageal motility and 24-hour pH recording in patients with gastroesophageal reflux. Am J Gastroenterol 88:525–529

    PubMed  CAS  Google Scholar 

  3. Cadiot G, Bruhat A, Rigaud D, Coste T, Vuagnat A, Benyedder Y, Vallot T, Le Guludec D, Mignon M (1997) Multivariate analysis of pathophysiological factors in reflux oesophagitis. Gut 40:167–174

    PubMed  CAS  Google Scholar 

  4. Fein M, Ritter MP, DeMeester TR, Oberg S, Peters JH, Hagen JA, Bremner CG (1999) Role of lower esophageal sphincter and hiatal hernia in the pathogenesis of gastroesophageal reflux disease. J Gastrointest Surg 3:405–410

    Article  PubMed  CAS  Google Scholar 

  5. Jones MP, Sloan SS, Rabine JC, Ebert CC, Huang CF, Kahrilas PJ (2001) Hiatal hernia size is the dominant determinant of esophagitis presence and severity in gastroesophageal reflux disease. Am J Gastroenterol 96:1711–1717

    Article  PubMed  CAS  Google Scholar 

  6. Avidan B, Sonnenberg A, Schnell TG, Sontag SJ (2002) Acid reflux is a poor predictor for severity of erosive reflux esophagitis. Dig Dis Sci 47:2565–2573

    Article  PubMed  CAS  Google Scholar 

  7. Freidin N, Mittal RK, McCallum RW (1991) Does body posture affect the incidence and mechanism of gastro-oesophageal reflux? Gut 32:133–136

    PubMed  CAS  Google Scholar 

  8. Leite LP, Johnston BT, Barrett J, Castell JA, Castell DO (1997) Ineffective esophageal motility (IEM). The primary finding in patients with nonspecific esophageal motility disorder. Dig Dis Sci 42:1859–1865

    Article  PubMed  CAS  Google Scholar 

  9. Ho S-C, Chang C-S, Wu C-Y, Chen G-H (2002) Ineffective esophageal motility is a primary motility disorder in gastroesophageal reflux disease. Dig Dis Sci 47:652–656

    Article  PubMed  Google Scholar 

  10. Simrén M, Silny J, Holloway R, Tack J, Janssens J, Sifrim D (2003) Relevance of ineffective oesophageal motility during oesophageal acid clearance. Gut 52:784–790

    Article  PubMed  Google Scholar 

  11. Diener U, Patti MG, Molena D, Fisichella PM, Way LW (2001) Esophageal dysmotiliy and gastroesophageal reflux disease. J Gastrointest Surg 5:260–265

    Article  PubMed  CAS  Google Scholar 

  12. Kahrilas PJ, Dodds WJ, Hogan WJ, Kern M, Arndorfer RC, Reece A (1986) Esophageal peristaltic dysfunction in peptic esophagitis. Gastroenterology 91:897–904

    PubMed  CAS  Google Scholar 

  13. Somani SK, Ghoshal UC, Saraswat VA, Aggarwal R, Misra A, Krishnani N, Naik SR (2004) Correlation of esophageal pH and motor abnormalities with endoscopic severity of reflux esophagitis. Dis Esophagus 17:58–62

    Article  PubMed  CAS  Google Scholar 

  14. Kim JH, Rhee P-L (2004) Ineffective esophageal motility is a possible marker of esophageal pathologic acid exposure. Gastroenterology 126(Suppl):A434

    Google Scholar 

  15. Carmagnola S, Oors J, Holloway R, Smout AJPM (2003) Mechanisms of incomplete bolus transport (BT) in healthy subjects assessed by impedancometry and sleeve sensor manometry. Gastroenterology 124(Suppl 1):A681

    Article  Google Scholar 

  16. Tutuian R, Castell DO (2004) Combined multichannel intraluminal impedance and manometry clarifies esophageal function abnormalities. Study in 350 patients. Am J Gastroenterol 99:1011–1019

    Article  PubMed  Google Scholar 

  17. Banki F, Mason RJ, Hagen JA, Bremner CG, Streets CG, Peters JH, DeMeester TR (2001) The crura and crura-sphincter pressure dynamics in patients with isolated upright and isolated supine reflux. Am Surg 67:1150–1156

    PubMed  CAS  Google Scholar 

  18. Tutuian R, Castell DO (2004) Clarification of the esophageal function defect in patients with manometric ineffective esophageal motility: studies using combined impedance-manometry. Clin Gastroenterol Hepatol 2:230–236

    Article  PubMed  Google Scholar 

  19. Kraus BB, Wu WC, Castell DO (1990) Comparison of lower esophageal sphincter manometrics and gastroesophageal reflux measured by 24-hour pH recording. Am J Gastroenterol 85:692–696

    PubMed  CAS  Google Scholar 

  20. Singh P, Adamopoulos A, Taylor RH, Colin-Jones DG (1992) Oesophageal motor function before and after healing of oesophagitis. Gut 33:1590–1596

    PubMed  CAS  Google Scholar 

  21. Rakic S, Stein HJ, DeMeester TR, Hinder RN (1997) Role of esophageal body in gastroesophageal reflux disease: implications for surgical management. J Am Coll Surg 185:380–387

    Article  PubMed  CAS  Google Scholar 

  22. Gillen P, Thornton J, Byrne PJ, Walsh TN, Hennessy TP (1994) Implications of upright gastro-oesophageal reflux. Br J Surg 81:239–240

    PubMed  CAS  Google Scholar 

  23. Ouatu-Lascar R, Lin OS, Fitzgerald RC, Triadafilopoulos G (2001) Upright versus supine reflux in gastroesophageal reflux disease. J Gastroenterol Hepatol 16:1184–1190

    Article  PubMed  CAS  Google Scholar 

  24. Eriksen CA, Sadek SA, Cranford C, Sutton D, Kennedy N, Cuschieri A (1988) Reflux oesophagitis and oesophageal transit: evidence for a primary oesophageal motor disorder. Gut 29:448–452

    PubMed  CAS  Google Scholar 

  25. Achem C, Achem SR, Stark ME, DeVault KR (2003) Failure of esophageal peristalsis in older patients: association with esophageal acid exposure. Am J Gastroenterol 98:35–39

    Article  PubMed  Google Scholar 

  26. Kruse-Andersen S, Wallin L, Madsen T (1988) The influence of age on esophageal acid defense mechanisms and spontaneous acid gastroesophageal reflux. Am J Gastroenterol 83:637–639

    PubMed  CAS  Google Scholar 

  27. Spence RA, Collins BJ, Parks TG, Love AHG (1985) Does age influence normal gastro-oesophageal reflux? Gut 26:799–801

    PubMed  CAS  Google Scholar 

  28. Ter RB, Johnston BT, Castell DO (1998) Influence of age and gender on gastroesophageal reflux in symptomatic patients. Dis Esophagus 11:106–108

    PubMed  CAS  Google Scholar 

  29. Fraser-Moodie CA, Norton B, Gornall C, Magnago S, Weale AR, Holmes GK (1999) Weight loss has an independent beneficial effect on symptoms of gastro-oesophageal reflux in patients who are overweight. Scand J Gastroenterol 34:337–340

    Article  PubMed  CAS  Google Scholar 

  30. Nilsson M, Johnsen R, Ye W, Hveem K, Lagergren J (2003) Obesity and estrogen as risk factors for gastroesophageal reflux symptoms. JAMA 290:66–72

    Article  PubMed  CAS  Google Scholar 

  31. Wajed SA, Streets CG, Bremner CG, DeMeester TR (2001) Elevated body mass disrupts the barrier to gastroesophageal reflux. Arch Surg 136:1014–1018

    Article  PubMed  CAS  Google Scholar 

  32. Patti MG, Goldberg HI, Arcerito M, Bortolasi L, Tong J, Way LW (1996) Hiatal hernia size affects lower esophageal sphincter function, esophageal acid exposure, and the degree of mucosal injury. Am J Surg 171:182–186

    Article  PubMed  CAS  Google Scholar 

  33. DeMeester TR, Lafontaine E, Joelsson BE, Skinner DB, Ryan JW, O’Sullivan GC, Brunsden BS, Johnson LF (1981) Relationship of a hiatal hernia to the function of the body of the esophagus and the gastroesophageal junction. J Thorac Cardiovasc Surg 82:547–558

    PubMed  CAS  Google Scholar 

  34. Sontag SJ, Schnell TG, Miller TQ, Nemchausky B, Serlovsky R, O’Connell S, Chejfec G, Seidel UJ, Brand L (1991) The importance of hiatal hernia in reflux esophagitis compared with lower esophageal sphincter pressure or smoking. J Clin Gastroenterol 13:628–643

    Article  PubMed  CAS  Google Scholar 

  35. Kasapidis P, Vassilakis JS, Tzovaras G, Chrysos E, Xynos E (1995) Effect of hiatal hernia on esophageal manometry and pH-metry in gastroesophageal reflux disease. Dig Dis Sci 40:2724–2730

    Article  PubMed  CAS  Google Scholar 

  36. van Heerwaarden MA, Samsom M, Smout AJPM (2000) Excess gastroesophageal reflux in patients with hiatus hernia is caused by mechanisms other than transient LES relaxations. Gastroenterology 119:1439–1446

    Article  Google Scholar 

  37. Xenos ES (2002) The role of esophageal motility and hiatal hernia in esophageal exposure to acid. Surg Endosc 16:914–920

    Article  PubMed  CAS  Google Scholar 

  38. Ott DJ, Glauser SJ, Ledbetter MS, Chen MY, Koufman JA, Gelfand DW (1995) Association of hiatal hernia and gastroesophageal reflux: correlation between presence and size of hiatal hernia and 24-hour pH monitoring of the esophagus. AJR Am J Roentgenol 165:557–559

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Psychophysiology Unit at the Department of Surgery, Medical University of Vienna, Vienna, Austria

    Georg Stacher, Johannes Lenglinger, Margit Eisler & Giselheid Stacher-Janotta

  2. Department of Nuclear Medicine, Medical University of Vienna, Vienna, Austria

    Martha Hoffmann

  3. Institute of Medical Statistics, Medical University of Vienna, Vienna, Austria

    Alexandra Goll

  4. Center of Biomedical Engineering and Physics, Medical University of Vienna, Vienna, Austria

    Helmar Bergmann

  5. Psychophysiologisches Laboratorium, Waehringer Guertel 18-20, A-1090, Wien, Austria

    Georg Stacher

Authors
  1. Georg Stacher
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Johannes Lenglinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Margit Eisler
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Martha Hoffmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alexandra Goll
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Helmar Bergmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Giselheid Stacher-Janotta
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Georg Stacher.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Stacher, G., Lenglinger, J., Eisler, M. et al. Esophageal Acid Exposure in Upright and Recumbent Postures: Roles of Lower Esophageal Sphincter, Esophageal Contractile and Transport Function, Hiatal Hernia, Age, Sex, and Body Mass. Dig Dis Sci 51, 1896–1903 (2006). https://doi.org/10.1007/s10620-006-9309-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-006-9309-8

Keywords

Search

Navigation