Abstract
Gastroesophageal reflux disease often occurs in patients with normal resting pressure and length of the lower esophageal sphincter. Such patients often have postprandial reflux. The mechanism of postprandial reflux remains controversial. To further clarify this, we studied the effect of carbonated beverages on the resting parameters of the lower esophageal sphincter. Nine asymptomatic healthy volunteers underwent lower esophageal sphincter manometry using a slow motorized pull through technique after ingestion of tap water and carbonated beverages. Resting pressure, overall length, and abdominal length of the lower esophageal sphincter were measured. All carbonated beverages produced sustained (20 minutes) reduction of 30–50% in all three parameters of the lower esophageal sphincter. In 62%, the reduction was of sufficient magnitude to cause the lower esophageal sphincter to reach a level normally diagnostic of incompetence. Tap water caused no reduction in sphincter parameters. Carbonated beverages, but not tap water, reduce the strength of the lower esophageal sphincter. This may be relevant to the pathogenesis of gastroesophageal reflux disease, especially in Western society.
Similar content being viewed by others
References
Zaninotto G, DeMeester TR, Schwizer W, Johannson KE, Cheng SCI. The lower esophageal sphincter in health and disease. Am J Surg 1988;155:104–111.
Dent J, Dodds WI, Friedman RH, Seikiguchi T, Hogan WJ, Arndorfer RC, Petrie DJ. Mechanism of gastroesophageal reflux in recumbent asymptomatic human subjects. J Clin Invest 1980;65:256–267.
Schoeman MN, Tippet MD, Akkermans LM, Dent J, Holloway RH. Mechanisms of gastroesophageal reflux in ambulant healthy human subjects. Gastroenterology 1995;108:83–91.
Babka JC, Castell DO. On the genesis of heartburn: The effects of specific foods on the lower esophagus sphincter. Dig Dis 1973;18:391–397.
Castell DO. Diet and the lower esophageal sphincter. Am J Clin Nutr 1975;28:1296–1298.
Chernow B, Castell DO. Diet and heartburn. JAMA 1979;241:2307–2308.
Richter JE, Castell DO. Drugs, foods, and other substances in the cause and treatment of reflux esophagitis. Med Clin North Am 1981;65:1223–1234.
Campos GM, Oberg S, Gastal O, Theisen J, Nigro JJ, Hagen JA, Costantini M, Bremner CG, DeMeester TR, Crookes PF. Manometry of the lower esophageal sphincter: Inter- and intraindividual variability of slow motorized pull-through versus station pull-through manometry. Dig Dis Sci 2003;48:1057–1061.
Dennish GW, Castell DO. Inhibitory effect of smoking on the lower esophageal sphincter. N Engl J Med 1971;284:1136–1137.
Wright LE, Castell DO. The adverse effect of chocolate on lower esophageal sphincter pressure. Am J Dig Dis 1975;20:703–707.
Murphy DW, Castell DO. Chocolate and heartburn: Evidence of increased esophageal acid exposure after chocolate ingestion. Am J Gastroenterol 1988;83:633–636.
Allen, MA. The effect of raw onions on acid reflux and reflux symptoms. Am J Gastroenterol 1990;85:377–380.
McArthur K, Hogan D, Isenberg JI. Relative stimulatory effects of commonly ingested beverages on gastric acid secretion in humans. Gastroenterology 1982;83:199–203.
Salmon PR, Fedail SS, Wurzner HP, Harvery RF, Read AE. Effect of coffee on human lower oesophageal function. Digestion 1981;21:69–73.
Thomas FB, Steinbaugh JT, Fromkes JJ, Mekhjian HS, Caldwell JH. Inhibitory effect of coffee on lower esophageal sphincter pressure. Gastroenterology 1980;79:1262–1266.
Kahrilas PJ, Shi G, Manka M, Joehl RJ. Increased frequency of transient lower esophageal sphincter relaxation induced by gastric distention in reflux patients with hiatal hernia. Gastroenterology 2000;118, 688–665.
Holloway RH, Hongo M, Berger K, McCallum RW. Gastric distention: A mechanism for postprandial gastroesophageal reflux. Gastroenterology 1985;89:779–784.
Bassey OO, Eyo EE, Akinhanmi GA. Incidence of hiatus hernia and gastro-oesophageal reflux in 1030 prospective barium meals in adult Nigerians. Thorax 1977;32:356–359.
Meyer GW, Castell DO. Human esophageal response during chest pain induced by swallowing cold liquids. JAMA 1981;246:2057–2059.
Mason RJ, DeMeester TR, Lund RJ, Peters JH, Crookes PF, Ritter M, Gadenstaetter M, Hagen JA. Nissen fundoplication prevents shortening of the sphincter during gastric distention. Gastroenterology 2000;118:688–695.
Ritter MP, Peters JH, DeMeester TR, Crookes PF, Mason RJ, Green L, Tefera L, Bremner CG. Outcome after laparoscopic fundoplication is not dependent on a structurally defective lower esophageal sphincter. J Gastrointest Surg 1998;2:567–572.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hamoui, N., Lord, R.V., Hagen, J.A. et al. Response of the lower esophageal sphincter to gastric distention by carbonated beverages. J Gastrointest Surg 10, 870–877 (2006). https://doi.org/10.1016/j.gassur.2005.11.010
Issue Date:
DOI: https://doi.org/10.1016/j.gassur.2005.11.010