IL-25-Induced Immunotherapy Against Obesity and the Associated Metabolic Syndrome

Abstract

Background/Aim: UES contractile reflex was described in 1957 by Creamer and Schlegel. The physiological role of this reflex in preventing pharyngeal reflux of gastric content and protecting the airway has been studied extensively. However, to date the defect of this reflex has not been described. Our aim was to characterize the UES pressure response to a variety of esophageal distensions in a group of patients with complaints of regurgitation and refluxattributed supraesophageal complications. Methods: We studied 8 patients (51 ± 20 yrs., 2F) with complaints of regurgitation and supraesophageal symptoms as well as 12 healthy asymptomatic controls (25 ± 5 yrs., 6F) in the supine position. Of the 8 patients, 6 had an intact esophagus, 1 had colonic interposition, and 1 had a partial esophagectomy and gastric pull-up. We tested the UES response to esophageal distension; simulating GE reflux by rapid and slow infusion of normal saline (10, 20, 30, and 60 mL) and air (10, 20, 30, 50 mL) and each injection was repeated 3 times. UES and esophageal pressures were monitored by high resolution intraluminal manometry. Pharyngeal reflux/regurgitation was monitored by high resolution esophagopharyngeal impedance recording. Patients were instructed to signal if pharyngeal reflux was perceived. Results: There were significant differences in the UES response to rapid and slow fluid injections between patients and controls (Chi-square< 0.0001) (Table). All patients but none of the controls reported pharyngeal reflux during slow and rapid esophageal fluid infusion. UES contraction(C) was absent during slow infusion only in patient group. Pharyngeal reflux was documented by impedance in six of eight patients with intact esophagus. All rapid fluid infusions produced UES contraction in the control group, while only 70-75% of rapid fluid infusions produced a UES contraction in patients. UES response to air distension, however, was relaxation(R) in both groups. Conclusions: UES contractile response to slow esophageal fluid distention is defective in patients with complaints of regurgitation and supraesophageal complications, allowing escape of refluxate into the pharynx. UES response to esophageal slow fluid infusion can serve as a test for recognizing this defect.