Cardiovascular compression of the esophagus and spread of gastro-esophageal reflux

Authors

  • A. Babaei,

    1. Division of Gastroenterology, Medical College of Wisconsin, Milwaukee, WI, USA
    2. Division of Gastroenterology, San Diego VA Health Care System & University of California, San Diego, CA, USA
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  • R. K. Mittal

    1. Division of Gastroenterology, San Diego VA Health Care System & University of California, San Diego, CA, USA
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Address for Correspondence
Dr. Ravinder K. Mittal, Division of Gastroenterology, VA Medical Center, University of California, San Diego, CA 92161, USA.
Tel: +1 (858) 552-7556; fax: +1 (858) 552-4327; e-mail: rmittal@ucsd.edu

Abstract

Background  Factors that determine the spread of gastro-esophageal reflux (GER) along the length of the esophagus are not known. We investigated if cardiovascular (CV) compressions on the esophagus may determine the spread of refluxate into the proximal esophagus.

Methods  High-resolution manometry (HRM) and multi-channel intra-luminal impedance recording (MIIR) were performed simultaneously in 10 normal subjects in the recumbent and upright positions. Pulsatile pressure increases on the esophagus (marker of CV compression) were identified on the HRM. Spread of refluxate into the esophagus was determined by the MIIR.

Key Results  Cardiovascular compression zones were observed in the esophagus in 9 out of 10 subjects in recumbent position. Forty percent of GER episodes were limited to the distal esophagus in the recumbent position and CV compression pressure was greater than distal esophageal pressure at the time of GER in all such cases. On the other hand, distal esophageal pressure was greater than CV compression pressure when the refluxate extended into the proximal esophagus. In the upright position, CV compression was less frequent than recumbent position and only 12% of GER episodes were limited to the distal esophagus.

Conclusions & Inferences  Cardiovascular compression of the esophagus is frequently observed in normal healthy subject and restricts the spread of refluxate into the proximal esophagus.

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