Skip to main content
SpringerLink
Log in

Decreased sympathetic inhibition in gastroesophageal reflux disease

  • Research Article
  • Published:
Clinical Autonomic Research Aims and scope Submit manuscript

Abstract

This study was undertaken to evaluate autonomic nervous system function in patients with gastroesophageal reflux disease. Based on clinical criteria, 28 consecutive patients with no history of heart, metabolic, or neurologic disease (mean age 41 y, range 20–62 y) reporting with upper gastrointestinal symptoms typical of gastroesophageal reflux underwent esophageal manometry, ambulatory 24-hour pH study with electrocardiographic monitoring, power spectral analysis of heart rate variability, and cardiovascular tests. Twelve healthy subjects served as controls. A positive result of prolonged esophageal pH study (pH in the distal esophagus less than 4, lasting more than 4.2% of recording time) was observed in 21 patients (reflux group); seven patients were categorized in the nonreflux group. No patient showed arrhythmias or any correlation between heart rate variability changes during electrocardiographic monitoring and episodes of reflux (pH less than 4, lasting more than 5 minutes). A decrease of sympathetic function occurred only in the reflux group (p<0.05) supported by the lower increase of systolic/diastolic blood pressure at sustained handgrip. No other cardiovascular tests showed statistically significant differences in the control or nonreflux groups. Total time reflux showed an inverse correlation with sympathetic function in the reflux group (r=-0.415, p<0.028). We concluded that there is some evidence for a slightly decreased sympathetic function in patients with gastroesophaged reflux disease that is inversely correlated with total time reflux. In these patients, decreased sympathetic function may cause dysfunction of intrinsic inhibitory control with increased transient spontaneous lower-esophageal sphincter relaxations, thus resulting in gastroesophageal reflux disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Nebel OT, Fornes MF, Castell DO. Symptomatic gastroesophageal reflux: incidence and precipitating factors.Dig Dis Sci 1976; 21:953–956.

    CAS  Google Scholar 

  2. Harvey RF, Salih SY, Read AE. Organic and functional disorders in 2000 gastroenterology outpatients.Lancet 1983; 1:632–634.

    CAS  PubMed  Google Scholar 

  3. Holloway RH, Dent J. Pathophysiology of gastroesophageal reflux disease: lower esophageal dysfunction in gastroesophageal reflux disease.Gastroenterol Clin North Am 1990; 19:517–536.

    CAS  PubMed  Google Scholar 

  4. Cunningham KM, Horowitz M, Riddel PS, et al. Relation among autonomic nerve dysfunction, oesophageal motility, and gastric emptying in gastro-esophageal reflux disease.Gut 1991; 32:1436–1440.

    CAS  PubMed  Google Scholar 

  5. Campo S, Traube M. Lower esophageal sphincter dysfunction in diffuse esophageal spasm.Am J Gastroenterol 1989; 84:928–932.

    CAS  PubMed  Google Scholar 

  6. Dodds WJ, Dent J, Hogan WJ, et al. Mechanisms of gastroensophageal reflux in patients with reflux esophagitis.N Engl J Med 1982; 307:1547–1552.

    CAS  PubMed  Google Scholar 

  7. Dent J, Holloway RH, Tooli J, et al. Mechanisms of lower esophageal incompetence in patients with symptomatic gastroesophageal reflux.Gut 1988; 29:1020–1028.

    CAS  PubMed  Google Scholar 

  8. Mittal RK, Fisher M. Electrical and mechanical inhibition of crural diaphragm during transient relaxation of the lower esophageal sphincter.Gastroenterology 1990; 99:1208–1212.

    Google Scholar 

  9. Kahrilas PJ, Dodds WJ, Hogan WJ. Esophageal peristaltic dysfunction in peptic esophagitis.Gastroenterology 1986; 91:897–904.

    CAS  PubMed  Google Scholar 

  10. Henderson RD, Mugashe F, Jeejeebhoy KN: The motor defect of esophagitis.Can J Surg 1974; 17:112–116.

    CAS  PubMed  Google Scholar 

  11. Campo S, Traube M. Manometric characteristics in idiopathic and reflux-associated esophageal spasm.Am J Gastroenterol 1992; 87:187–189.

    CAS  PubMed  Google Scholar 

  12. Mittal RK, WcCallum RW. Characteristics and frequency of transient relaxations of the lower esophageal sphincter in patients with reflux esophagitis.Gastroenterology 1988; 95:593–599.

    CAS  PubMed  Google Scholar 

  13. Mittal RK, Holloway RH, Penagini R, et al. Transient lower esophageal sphincter relaxation.Gastroenterology 1995; 109:601–610.

    CAS  PubMed  Google Scholar 

  14. Mittal RK, Holloway RH, Dent J. Effect of atropine on the frequency of reflux and transient lower esophageal sphincter relaxation in normal subjects.Gastroenterology 1995; 109:1547–1554.

    CAS  PubMed  Google Scholar 

  15. Penagini R, Bianchi PA. Effect of morphine on gastroesophageal reflux and transient lower esophageal sphincter relaxation.Gastroenterology 1997; 113:409–414.

    Article  CAS  PubMed  Google Scholar 

  16. Stewart IM, Hosking DJ, Preston BJ, et al. Oesophageal motor changes in diabetes mellitus.Thorax 1976; 31:278–283.

    CAS  PubMed  Google Scholar 

  17. Heatley RV, Collins RJ, James PD, et al. Vagal function in relation to gastro-esophageal reflux and associated motility changes.Br Med J 1980; 280:755–757.

    CAS  PubMed  Google Scholar 

  18. Boulant J, Fioramonti J, Dpoigny M, et al. Cholecystokinin and nitric oxide in transient lower esophageal sphincter relaxation to gastric distension in dogs.Gastroenterology 1994; 107:1059–1066.

    CAS  PubMed  Google Scholar 

  19. Mittal RK, Chiareli C, Liu J, et al. Atropine inhibits gastric distension and pharyngeal receptor mediated lower oesophageal sphincter relaxation.Gut 1997; 41:285–290.

    CAS  PubMed  Google Scholar 

  20. Lidums I, Checklin H, Mittal RK, et al. Effect of atropine on gastrooesophageal reflux and transient lower oesophageal sphincter relaxations in patients with gastro-oesophageal reflux disease.Gut 1998; 43:12–16.

    CAS  PubMed  Google Scholar 

  21. Bharucha AE, Camilleri M, Low PA, et al. Autonomic dysfunction in gastrointestinal motility disorders.Gut 1993; 34:397–401.

    CAS  PubMed  Google Scholar 

  22. Richards WG, Sugarbaker DJ. Neuronal control of esophageal function.Chest Surg Clin N Am 1995; 5:157–171.

    CAS  PubMed  Google Scholar 

  23. Mathias CJ. The classification and nomenclature of autonomic disorders-ending chaos, resolving conflict and hopefully achieving clarity.Clin Auton Res 1995; 5:307–310.

    Article  CAS  PubMed  Google Scholar 

  24. Mathias CJ. Autonomic disorders and their recognition.N Engl J Med 1997; 336:721–724.

    Article  CAS  PubMed  Google Scholar 

  25. Behar J, Sheahan DC. Histology abnormalities in reflux esophagitis.Arch Pathol Lab Med 1984; 100:242–245.

    Google Scholar 

  26. Traube M, McCallum RW. Primary oesophageal motility disorders: current therapeutic concepts.Drugs 1985; 30:66–77.

    CAS  PubMed  Google Scholar 

  27. Richter JE, Castell DO: Diffuse esophageal spasm: a reappraisal.Ann Intern Med 1984; 100:242–244.

    CAS  PubMed  Google Scholar 

  28. Johnson LF, DeMeester TR: Twenty-four hour pH monitoring of the distal esophagus. A quantitative measure of gastroesophageal reflux.Am J Gastroenterol 1974; 62:325–332.

    CAS  PubMed  Google Scholar 

  29. Mattox HE, Richter JE: Prolonged ambulatory esophageal pH monitoring in the evaluation of gastroesophageal reflux disease.Am J Med 1990; 89:345–356.

    Article  PubMed  Google Scholar 

  30. De Meester TR, Wang Cl, Wernly JA, et al. Technique, indications, and clinical use of 24 hour esophageal pH monitoring.J Thorac Cardiovasc Surg 1980; 79:656–670.

    Google Scholar 

  31. Ewing DJ, Martin CN, Young RJ, et al. The value of cardiovascular autonomic function tests: 10 years experience in diabetes.Diabetes Care 1985; 8:491–497.

    CAS  PubMed  Google Scholar 

  32. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Heart rate variability. Standards of measurements, physiological interpretation, and clinical use.Circulation 1996; 93:1043–1065.

    Google Scholar 

  33. Camilleri M, Ford MJ. Functional gastrointestinal disease and the autonomic nervous system: a way ahead?Gastroenterology 1994; 106:1114–1118.

    CAS  PubMed  Google Scholar 

  34. Rossini PM, Massa R, Sancesario G, et al. Sudomotor skin test to brain stimulation do not depend on nerve sensory fiber functionality.Electroenceph Clin Neurophysiol 1993; 89:447–451.

    CAS  PubMed  Google Scholar 

  35. Giudicelli R, Dupin B, Surpas P, et al. Gastroesophageal reflux and respiratory manifestations: diagnostic approach, therapeutic indications and results.Ann de Chirurgie 1990; 44:552–554.

    CAS  Google Scholar 

  36. Winters C Jr, Spurling TJ, Chobanian SJ. Barrett's esophagus: a prevalent, occult complication of gastroesophageal reflux disease.Gastroenterology 1987; 92:118–124.

    PubMed  Google Scholar 

  37. Lagergren J, Begstrom R, Lindgren A, et al. Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma.N Engl J Med 1999; 340:825–831.

    Article  CAS  PubMed  Google Scholar 

  38. Eastwood GL, Beck BD, Castell DO, et al. Beneficial effect of Indomethacin on acid-induced esophagitis in cats.Dig Dis Sci 1981; 26:601–608.

    Article  CAS  PubMed  Google Scholar 

  39. Biancani P, Barwick K, Selling J, et al. Effects of acute experimental esophagitis on mechanical properties of the lower esophageal sphincter.Gastroenterology 1984; 87:8–16.

    CAS  PubMed  Google Scholar 

  40. Salapatek AMF, Diamant NE. Assessment of neural inhibition of the lower esophageal sphincter in cats with esophagitis.Gastroenterology 1993; 104:810–818.

    CAS  PubMed  Google Scholar 

  41. Chakraborty TK, Ogilvia AL, Heading RC, et al. Abnormal cardiovascular reflexes in patients with gastro-oesophageal reflux.Gut 1989; 30:46–49.

    CAS  PubMed  Google Scholar 

  42. Dent J, Dodds WJ, Friedman RH, et al. Mechanism of gastroesophageal reflux in recumbent asymptomatic human subjects.J Clin Invest 1980; 65:256–267.

    CAS  PubMed  Google Scholar 

  43. Holloway RH, Penagini R, Ireland AC. Criteria for objective definition of transient lower esophageal sphincter relaxation.Am J Physiol 1995; 268:G128-G133.

    CAS  PubMed  Google Scholar 

Download references

Author information

Author notes

  1. Salvatore M. A. Campo M.D.

    Present address: Gastroenterology Unit, Ospedale Nuovo Regina Margherita, Rome, Italy

Authors and Affiliations

  1. Centro Ricovero e Cura a Carattere Scientifico-Associazione Fatebenefratelli per la Ricerca, Divisione di Medicina, Ospedale S. Giovanni Calibita Fatebenefratelli, Isola Tiberina, Rome, Italy

    Salvatore M. A. Campo M.D. & Enrico Bologna M.D.

  2. Divisione di Neurologia, Ospedale S. Giovanni Calibita Fatebenefratelli, Isola Tiberina, Rome, Italy

    Gennaro Martino M.D. & Paolo Maria Rossini M.D.

  3. Clinica Medica, Università Tor Vergata, Rome, Italy

    Ambrogio Capria M.D., Fabiola Antonucci M.D., Angela Ciamei M.D. & Dario Cannata M.D.

Authors
  1. Salvatore M. A. Campo M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ambrogio Capria M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fabiola Antonucci M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gennaro Martino M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Angela Ciamei M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Paolo Maria Rossini M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Enrico Bologna M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Dario Cannata M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Salvatore M. A. Campo M.D..

Rights and permissions

Reprints and permissions

About this article

Cite this article

Campo, S.M.A., Capria, A., Antonucci, F. et al. Decreased sympathetic inhibition in gastroesophageal reflux disease. Clinical Autonomic Research 11, 45–51 (2001). https://doi.org/10.1007/BF02317802

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02317802

Key words

Search

Navigation