Acid gastro-oesophageal reflux episodes as related to the quality of preceding peristalsis. A study in normal subjects.

It has earlier been demonstrated after long-term monitoring of pH and peristalsis in the oesophagus that episodes of acid gastro-oesophageal reflux occur in normal volunteers. To determine whether there is a connection between gastro-oesophageal reflux and prior peristalsis, pH and peristalsis were monitored for 12 h in 26 asymptomatic subjects. The recorded peristalsis was divided into brief bursts of peristaltic contractions (less than or equal to 60 sec) and more prolonged continuous activity. Peristaltic periods were limited to prior and subsequent peristalsis by a non-peristaltic course of greater than 30 sec. Continuous peristalsis was defined as a sequence of peristaltic contractions with a mutual distance between individual peristaltic waves of greater than or equal to 30 sec. A total of 81 episodes of reflux were recorded, of which 67 were preceded by peristaltic activity. Brief bursts of peristalsis, unrelated to reflux episodes, were frequently terminated by bolus-transporting peristaltic waves (p less than 0.001). When the last contraction before reflux was considered, an increased frequency of non-propagating peristalsis was found (p less than 0.01). In addition, a closer time relationship was observed between peristalsis and reflux if the last contraction was of the upper segmentary type, as compared with propagating activity (p less than 0.001). In conclusion, reflectory sphincter relaxation producing reflux may possibly be triggered by contractions in the upper part of the oseophagus, not followed by a bolus-transporting peristaltic wave.