Increase of transient lower esophageal sphincter relaxation associated with cascade stomach

Abstract

We previously reported that cascade stomach was associated with reflux symptoms and esophagitis. Delayed gastric emptying has been believed to initiate transient lower esophageal sphincter relaxation (TLESR). We hypothesized that cascade stomach may be associated with frequent TLESR with delayed gastric emptying. Eleven subjects with cascade stomach and 11 subjects without cascade stomach were enrolled. Postprandial gastroesophageal manometry and gastric emptying using a continuous ¹³C breath system were measured simultaneously after a liquid test meal. TLESR events were counted in early period (0-60 min), late period (60-120 min), and total monitoring period. Three parameters of gastric emptying were calculated: the half emptying time, lag time, and gastric emptying coefficient. The median frequency of TLESR events in the cascade stomach and non-cascade stomach groups was 6.0 (median), 4.6 (interquartile range) vs 5.0, 3.0 in the early period, 5.0, 3.2 vs 3.0, 1.8 in the late period, and 10.0, 6.2 vs 8.0, 5.0 in the total monitoring period. TLESR events were significantly more frequent in the cascade stomach group during the late and total monitoring periods. In contrast, gastric emptying parameters showed no significant differences between the two groups. We concluded that TLESR events were significantly more frequent in persons with cascade stomach without delayed gastric emptying.

Keywords: cascade stomach; esophageal manometry; gastric emptying; gastroesophageal reflux disease; liquid test meal.

Fig. 1

Classification of the stomach on X-ray films. CS was defined by detection of an air-fluid level in the fundus on an upright barium X-ray film. CS, cascade stomach; non-CS, non-cascade stomach.

Fig. 2

Example of transient lower esophageal sphincter relaxation. LES, lower esopahgeal sphincter.

Fig. 3

Comparison of the number of TLESR events. During the late period and, total period, transient lower esophageal sphincter relaxation (TLESR) events were significantly more frequent in the CS group than in the non-CS group. TLESR events were also more frequent during the early period in the CS group than in the non-CS group, but there was no significant difference. CS, cascade stomach; TLESR, transient lower esophageal sphincter relaxation; TP, total monitoring period; EP, early monitoring period; LP, late monitoring period, *p<0.05.

Fig. 4

Results of the breath test. Continuous¹³CO₂ excretion (%dose/h) in the two groups. Values are the mean excretion of ¹³CO₂ in the CS group and the non-CS group (mean ± SD).