Korean J Gastroenterol.  2012 Mar;59(3):205-210. 10.4166/kjg.2012.59.3.205.

Transient Lower Esophageal Sphincter Relaxation and the Related Esophageal Motor Activities

• Han SH
• Hong SJ

• KMID: 1245204
• DOI: http://doi.org/10.4166/kjg.2012.59.3.205

Abstract

Transient lower esophageal sphincter (LES) relaxation (TLESR) is defined as LES relaxation without a swallow. TLESRs are observed in both of the normal individuals and the patients with gastroesophageal reflux disorder (GERD). However, TLESR is widely considered as the major mechanism of the GERD. The new equipments such as high resolution manometry and impedance pH study is helped to understand of TLESR and the related esophageal motor activities. The strong longitudinal muscle contraction was observed during development of TLESR. Most of TLESRs are terminated by TLESR related motor events such as primary peristalsis and secondary contractions. The majority of TLESRs are associated with gastroesophageal reflux. Upper esophageal sphincter (UES) contraction is mainly associated with liquid reflux during recumbent position and UES relaxation predominantly related with air reflux during upright position. The frequency of TLESR in GERD patients seems to be not different compared to normal individuals, but the refluxate of GERD patients tend to be more acidic during TLESR.

Keyword

Transient high resolution manometry; Gastroesophageal reflux

MeSH Terms

Esophageal Sphincter, Lower/*physiology
Esophagogastric Junction/physiology
Esophagus/*physiology
Gastroesophageal Reflux/*physiopathology
Humans
Muscle Relaxation/physiology

Figure

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  Fig. 1 Episodes of transient lower esophageal sphincter (LES) relaxation (TLESR). The panels showed that TLESR events were terminated by primary peristalsis (A), full secondary contraction (B), and partial secondary contraction (C). Panel D revealed incomplete TLSESR relaxation and LES lift of 9 mm.

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  Fig. 2 An episode of complete transient lower esophageal sphincter relaxation (TLESR). Panel A showed the lower esophageal sphincter relaxed completely and quickly. The high resolution manometry with multichannel intraluminal impedance study indicated the liquid reflux during this event of complete TLESR in Panel B.

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  Fig. 3 The responses of upper esophageal sphincter during transient lower esophageal sphincter relaxation (TLESR). Several upper esophageal sphincter (UES) relaxations were combined with TLESR on Panel A. The pressure waves on color plot showed rapidly increased esophageal pressure during UES relaxation period on Panel B. Impedance waves showed the characteristics of refluxate during TLESR on Panel C. The increased values of impedance suggested air reflux accompanying UES relaxation. The combined color plot on Panel D revealed distal liquid reflux and proximal air reflux during TLESR.

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