Gastric dysrhythmias occur in gastro-oesophageal reflux disease complicated by food regurgitation but not in uncomplicated reflux

Abstract

Aim: To investigate gastric pacemaker activity in gastro-oesophageal reflux disease using the electrogastrogram.

Patients: Forty patients with gastro-oesophageal reflux disease (20 with acid reflux, 20 with the additional symptom of food regurgitation) and 30 asymptomatic controls.

Methods: Patients were studied using an electrogastrogram, oesophageal manometry, and 24 hour ambulatory oesophageal pH analysis.

Results: An abnormal electrogastrogram was recorded in two (7%) controls, two (10%) patients with acid reflux, and 10 (50%) patients with food regurgitation. Food regurgitators had significantly more gastric dysrhythmias (tachygastrias) both before (p<0.02) and after (p<0.01) a test meal. Gastric pacemaker activity was also significantly less stable following the test meal in food regurgitators (p<0.003). Patients with food regurgitation and an abnormal electrogastrogram had higher oesophageal acid exposure than those with a normal electrogastrogram (p<0.05).

Conclusions: The electrogastrogram is usually normal in gastro-oesophageal reflux disease but an abnormal rhythm occurred in half of our patients with the additional symptom of food regurgitation. Furthermore, an abnormal electrogastrogram is associated with increased oesophageal acid exposure.

Figure 1

An example of (A) an electrogastrogram (EGG) signal and (B) a pseudo three dimensional representation of its analysis in a control subject. Normal electrical activity of 2-4 cycles per minute is present after a test meal.

Figure 2

An example of (A) an electrogastrogram (EGG) signal and (B) a pseudo three dimensional representation of its analysis in a patient with food regurgitation. An abnormal EGG is present, with gastric dysrhythmias occurring after a test meal.