Abstract
Esophago-pharyngeal regurgitation is implicated in various otolaryngologic and respiratory disorders. The pathophysiological mechanisms causing regurgitation are still largely unknown.AimTo determine the principal mechanisms behind esophago-pharyngeal regurgitation.MethodsWe studied 11 patients with extra-esophageal GORD symptoms in whom esophago-pharyngeal acid regurgitation had previously been demonstrated using ambulatory, dual (pharyngo-esophageal) pH metry (>2 episodes/day using previously validated pH-metric criteria). Patients underwent continuous, 24 hr, stationary monitoring of pharyngo-esophageal manometry and dual (pharyngeal and esophageal) pH recordings. They were intubated with a 14-channel manometric assembly incorporating 2 sleeve sensors monitoring the upper and lower esophageal sphincters simultaneously. A dual pH catheter recorded pH signals 2 cm above the UES midpoint and 7 cm above the LES midpoint.ResultsA total of 32 episodes of spontaneous esophago-pharyngeal acid regurgitation were recorded. All episodes occurred in the upright posture and 91% occurred within 3 hrs post-prandium. All regurgitation events were associated with a relaxation of the UES, which were classified as transient non-swallow related relaxations in 29 (91%) and swallow-related in the remaining 3 (9%). Straining was an additional associated factor in 41% of regurgitation events, but strain alone was not sufficient to cause esophago-pharyngeal regurgitation.ConclusionSome form of active UES relaxation is necessary for regurgitation to occur. The dominant mechanism underlying esophago-pharyngeal acid regurgitation is the non-swallow related, transient UES relaxation.Level of EvidenceN/A
Highlights
Some form of active UES relaxation is necessary for regurgitation to occur
Esophago-pharyngeal regurgitation is implicated in otolaryngologic and respiratory disorders such as cough, asthma and laryngitis [1,2,3]
The pathophysiological mechanisms causing esophago-pharyngeal regurgitation, that can potentially lead to injury of supra-esophageal structures, are largely unknown
Summary
Esophago-pharyngeal regurgitation is implicated in otolaryngologic and respiratory disorders such as cough, asthma and laryngitis [1,2,3]. Categorical proof of a causative link between pH events and symptoms in these disorders in individual patients remains elusive. The pathophysiological mechanisms causing esophago-pharyngeal regurgitation, that can potentially lead to injury of supra-esophageal structures, are largely unknown. Factors leading to the development of gastro-esophageal reflux disease may not play a central role, as a large proportion of patients with laryngitis that is believed to be acid-related, have normal esophageal motility and physiological levels of esophageal acid exposure [2,4,5]. Previous studies in humans and animals have shown that experimental rapid esophageal distension by gas can trigger the UES relaxation response [8,9].
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