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Gut. Dec 1991; 32(12): 1436–1440.
PMCID: PMC1379238

Relations among autonomic nerve dysfunction, oesophageal motility, and gastric emptying in gastro-oesophageal reflux disease.


Recent studies suggest that vagal nerve dysfunction may be important in the aetiology of gastro-oesophageal reflux disease. Delayed oesophageal transit and slowed gastric emptying occur frequently and may also be of pathogenic importance. In 48 patients with gastro-oesophageal reflux disease we studied the prevalence of and relations between autonomic nerve dysfunction (as assessed by cardiovascular reflex tests) and oesophageal transit, oesophageal motility, gastric emptying, and endoscopic grade of oesophagitis. Of the 48 patients, 21 (44%) had abnormal autonomic nerve function, which was predominantly parasympathetic. Oesophageal transit was delayed in 28% of the patients and gastric emptying of the solid component of the meal was delayed in 46%. Oesophageal transit was significantly (p less than 0.007) slower in patients with abnormal autonomic nerve function. The percentage of synchronous oesophageal contractions was related to the score for autonomic nerve dysfunction (r = 0.40, p less than 0.05). There was no significant relation of autonomic nerve dysfunction to either delayed gastric emptying or endoscopic grade of oesophagitis. We conclude that in gastro-oesophageal reflux disease there is a high prevalence of parasympathetic nerve dysfunction which relates to delayed oesophageal transit and abnormal peristalsis and may therefore be of pathogenic importance.

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Selected References

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  • Dent J. Recent views on the pathogenesis of gastro-oesophageal reflux disease. Baillieres Clin Gastroenterol. 1987 Oct;1(4):727–745. [PubMed]
  • Holloway RH, Dent J. Pathophysiology of gastroesophageal reflux. Lower esophageal sphincter dysfunction in gastroesophageal reflux disease. Gastroenterol Clin North Am. 1990 Sep;19(3):517–535. [PubMed]
  • Kahrilas PJ, Dodds WJ, Hogan WJ, Kern M, Arndorfer RC, Reece A. Esophageal peristaltic dysfunction in peptic esophagitis. Gastroenterology. 1986 Oct;91(4):897–904. [PubMed]
  • Behar J, Ramsby G. Gastric emptying and antral motility in reflux esophagitis. Effect of oral metoclopramide. Gastroenterology. 1978 Feb;74(2 Pt 1):253–256. [PubMed]
  • King PM, Pryde A, Heading RC. Transpyloric fluid movement and antroduodenal motility in patients with gastro-oesophageal reflux. Gut. 1987 May;28(5):545–548. [PMC free article] [PubMed]
  • Russell CO, Pope CE, 2nd, Gannan RM, Allen FD, Velasco N, Hill LD. Does surgery correct esophageal motor dysfunction in gastroesophageal reflux. Ann Surg. 1981 Sep;194(3):290–296. [PMC free article] [PubMed]
  • Maddern GJ, Jamieson GG. Oesophageal emptying in patients with gastro-oesophageal reflux. Br J Surg. 1986 Aug;73(8):615–617. [PubMed]
  • Roland J, Peters O, Piepsz A, Devis G, Jonckheer M, Ham HR. Evaluation of oesophageal transit in patients with minor peptic oesophagitis. Nucl Med Commun. 1989 Mar;10(3):161–165. [PubMed]
  • Kahrilas PJ, Dodds WJ, Hogan WJ. Effect of peristaltic dysfunction on esophageal volume clearance. Gastroenterology. 1988 Jan;94(1):73–80. [PubMed]
  • McCallum RW, Berkowitz DM, Lerner E. Gastric emptying in patients with gastroesophageal reflux. Gastroenterology. 1981 Feb;80(2):285–291. [PubMed]
  • Maddern GJ, Chatterton BE, Collins PJ, Horowitz M, Shearman DJ, Jamieson GG. Solid and liquid gastric emptying in patients with gastro-oesophageal reflux. Br J Surg. 1985 May;72(5):344–347. [PubMed]
  • Collins BJ, McFarland RJ, O'Hare MM, Shaw C, Buchanan KD, Love AH. Gastric emptying of a solid-liquid meal and gastro-intestinal hormone responses in patients with erosive oesophagitis. Digestion. 1986;33(2):61–68. [PubMed]
  • Hillemeier AC, Grill BB, McCallum R, Gryboski J. Esophageal and gastric motor abnormalities in gastroesophageal reflux during infancy. Gastroenterology. 1983 Apr;84(4):741–746. [PubMed]
  • Heatley RV, Collins RJ, James PD, Atkinson M. Vagal function in relation to gastro-oesophageal reflux and associated motility changes. Br Med J. 1980 Mar 15;280(6216):755–757. [PMC free article] [PubMed]
  • Ogilvie AL, James PD, Atkinson M. Impairment of vagal function in reflux oesophagitis. Q J Med. 1985 Jan;54(213):61–74. [PubMed]
  • Chakraborty TK, Ogilvie AL, Heading RC, Ewing DJ. Abnormal cardiovascular reflexes in patients with gastro-oesophageal reflux. Gut. 1989 Jan;30(1):46–49. [PMC free article] [PubMed]
  • Ewing DJ, Clarke BF. Diagnosis and management of diabetic autonomic neuropathy. Br Med J (Clin Res Ed) 1982 Oct 2;285(6346):916–918. [PMC free article] [PubMed]
  • Collins PJ, Horowitz M, Cook DJ, Harding PE, Shearman DJ. Gastric emptying in normal subjects--a reproducible technique using a single scintillation camera and computer system. Gut. 1983 Dec;24(12):1117–1125. [PMC free article] [PubMed]
  • Maddern GJ, Slavotinek JP, Collins PJ, Jamieson GG. The effect of posture and pH on solid and liquid oesophageal emptying. Clin Physiol. 1985 Oct;5(5):425–432. [PubMed]
  • Dent J. A new technique for continuous sphincter pressure measurement. Gastroenterology. 1976 Aug;71(2):263–267. [PubMed]
  • Dent J, Holloway RH, Toouli J, Dodds WJ. Mechanisms of lower oesophageal sphincter incompetence in patients with symptomatic gastrooesophageal reflux. Gut. 1988 Aug;29(8):1020–1028. [PMC free article] [PubMed]
  • Little AG, DeMeester TR, Kirchner PT, O'Sullivan GC, Skinner DB. Pathogenesis of esophagitis in patients with gastroesophageal reflux. Surgery. 1980 Jul;88(1):101–107. [PubMed]
  • Blackwell JN, Castell DO. Oesophageal motility: recent advances and implications. Clin Sci (Lond) 1984 Aug;67(2):145–151. [PubMed]
  • Holloway RH, Lange RC, Plankey MW, McCallum RW. Detection of esophageal motor disorders by radionuclide transit studies. A reappraisal. Dig Dis Sci. 1989 Jun;34(6):905–912. [PubMed]
  • Eriksen CA, Sadek SA, Cranford C, Sutton D, Kennedy N, Cuschieri A. Reflux oesophagitis and oesophageal transit: evidence for a primary oesophageal motor disorder. Gut. 1988 Apr;29(4):448–452. [PMC free article] [PubMed]
  • Richter JE, Blackwell JN, Wu WC, Johns DN, Cowan RJ, Castell DO. Relationship of radionuclide liquid bolus transport and esophageal manometry. J Lab Clin Med. 1987 Feb;109(2):217–224. [PubMed]
  • Gill RC, Bowes KL, Murphy PD, Kingma YJ. Esophageal motor abnormalities in gastroesophageal reflux and the effects of fundoplication. Gastroenterology. 1986 Aug;91(2):364–369. [PubMed]
  • Holloway RH, Hongo M, Berger K, McCallum RW. Gastric distention: a mechanism for postprandial gastroesophageal reflux. Gastroenterology. 1985 Oct;89(4):779–784. [PubMed]
  • Dubois A. Clinical relevance of gastroduodenal dysfunction in reflux esophagitis. J Clin Gastroenterol. 1986;8 (Suppl 1):17–25. [PubMed]
  • Fink SM, Lange RC, McCallum RW. Effect of metoclopramide on normal and delayed gastric emptying in gastroesophageal reflux patients. Dig Dis Sci. 1983 Dec;28(12):1057–1061. [PubMed]
  • Maddern GJ, Jamieson GG. Fundoplication enhances gastric emptying. Ann Surg. 1985 Mar;201(3):296–299. [PMC free article] [PubMed]
  • Maddern GJ, Jamieson GG, Chatterton BE, Collins PJ. Is there an association between failed antireflux procedures and delayed gastric emptying? Ann Surg. 1985 Aug;202(2):162–165. [PMC free article] [PubMed]

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