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Pathophysiological Determinants of Gastroesophageal Reflux, and the Role of Esophageal and Airway Receptors

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Pneumological Aspects of Gastroesophageal Reflux

Abstract

Although the human body is well equipped to counteract the occurrence of a reflux of gastric contents into the esophagus and possibly into the more proximal airway, regurgitation does occur, especially in elderly subjects and in newborns. In healthy subjects, physiological mechanisms offer a well-developed degree of protection against gastroesophageal reflux (GER) as shown by its absence even in subjects maintained in a head-down posture [1]. The most common disorder leading to GER is a functional or structural abnormality of the lower esophageal sphincter affecting either one of its two components: smooth muscle or striated muscle from the crural portion of the diaphragm [1].

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References

  1. Mittal RK, Balaban DH (1997) The esophagogastric junction. N Engl J Med 336:924–932

    Article  PubMed  CAS  Google Scholar 

  2. Boyle JT, Tuchman DN, Altschuler SM, Nixon TE, Pack AI, Cohen S (1985) Mechanisms for the association of gastroesophageal reflux and bronchospasm. Am Rev Respir Dis 131:S16–S20

    PubMed  CAS  Google Scholar 

  3. Harding SM, Richter JE (1997) The role of gastroesophageal reflux in chronic cough and asthma. Chest 111:1389–1402

    Article  PubMed  CAS  Google Scholar 

  4. Kahrilas PJ (1996) Gastroesophageal reflux disease. JAMA 276:983–988

    Article  PubMed  CAS  Google Scholar 

  5. Koufman JA (1991) The otolaryngologic manifestations of gastroesophageal reflux disease (GERD): a clinical investigation of 255 patients using ambulatory 24-hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury. Laryngoscope 101:1–78

    Article  PubMed  CAS  Google Scholar 

  6. Schan CA, Harding SM, Haile JM, Bradley LA, Richter JE (1994) Gastroesophageal reflux-induced bronchoconstriction. An intraesophageal acid infusion study using state-of-the-art technology. Chest 106:731–737

    CAS  Google Scholar 

  7. Tuchman DN, Boyle JT, Pack AI, Scwartz J, Kokonos M, Spitzer AR, Cohen S (1984) Comparison of airway responses following tracheal or esophageal acidification in the cat. Gastroenterology 87:872–881

    PubMed  CAS  Google Scholar 

  8. Wesseling G, Brummer RJ, Wouters EF, ten Velde GP (1993) Gastric asthma? No change in respiratory impedance during intraesophageal acidification in adult asthmatics. Chest 104:1733–1736

    Article  PubMed  CAS  Google Scholar 

  9. Donnelly RJ, Berrisford RG, Jack CI, Tran JA, Evans CC (1993) Simultaneous tracheal and esophageal pH monitoring: investigating reflux-associated asthma. Ann Thorac Surg 56:1029–1034

    Article  PubMed  CAS  Google Scholar 

  10. Paintal AS (1963) Vagal afferent fibres. In: Kramer K, Krayer O, Lehnartz E, Murait A, Weber HH (eds) Ergebnisse der Physiologie, Band 52. Springer, Berlin Heidelberg New York, 74–156

    Google Scholar 

  11. Andrews PL, Lang KM (1982) Vagal afferent discharge from mechanoreceptors in the lower oesophagus of the ferret. J Physiol (Lond) 322:29P

    Google Scholar 

  12. Clerc N, Mei N (1983) Vagal mechanoreceptors located in the lower oesophageal sphincter of the cat. J Physiol (Lond) 336:487–498

    CAS  Google Scholar 

  13. Falempin M, Mei N, Rousseau JP (1978) Vagal mechanoreceptors of the inferior thoracic oesophagus, the lower oesophageal sphincter and the stomach in the sheep. Pflügers Arch 373:25–30

    Article  PubMed  CAS  Google Scholar 

  14. Satchell PM (1984) Canine oesophageal mechanoreceptors. J Physiol (Lond) 346:287–300

    CAS  Google Scholar 

  15. Sekizawa S-I, Ishikawa T, Sant’Ambrogio FB, Sant’Ambrogio G (1998) Vagal esophageal receptors in the anesthetized dog. FASEB J 12:A782

    Google Scholar 

  16. Mei N (1970) Mécanorécepteurs vagaux digestifs chez le chat. Exp Brain Res 11:502–514

    PubMed  CAS  Google Scholar 

  17. Cherniack NS, Haxhiu MA, Mitra J, Strohl K, Van Lunteren E (1984) Responses of upper airway, intercostal and the diaphragm muscle activity to stimulation of oesophageal afferents. J Physiol (Lond) 349:15–25

    CAS  Google Scholar 

  18. Ayres JG, Miles JF (1996) Oesophageal reflux and asthma. Eur Respir J 9:1073–1078

    Article  PubMed  CAS  Google Scholar 

  19. Mays EE (1976) Intrinsic asthma in adults. Association with gastroesophageal reflux. JAMA 236:2626–2628

    Article  CAS  Google Scholar 

  20. Olson NR (1991) Laryngopharyngeal manifestations of gastroesophageal reflux disease. Otolaryngol Clin North Am 24:1201–1213

    PubMed  CAS  Google Scholar 

  21. Sataloff RT, Speigel JR, Hawkshaw M, Rosen DC (1993) Gastroesophageal reflux laryngitis. Ear Nose Throat J 72:113–114

    PubMed  CAS  Google Scholar 

  22. Ishikawa T, Sekizawa S-I, Sant’Ambrogio FB, Sant’Ambrogio G (1998) Effect of esophageal vs. laryngeal HC1-pepsin instillations on airway smooth muscle in adult dogs. FASEB J 12:A784

    Google Scholar 

  23. Ishikawa T, Sekizawa S, Sant’Ambrogio FB, Sant’Ambrogio G (1998) Endotracheal cuff pressure as an index of airway smooth muscle activity: comparison with total lung resistance. Respir Physiol 112:175–184

    Article  PubMed  CAS  Google Scholar 

  24. Tatár M, Pécová R (1996) The effect of experimental gastroesophageal reflux on the cough in anesthetized cats. Bratisl Lek Listy 5:284–288

    Google Scholar 

  25. Sant’Ambrogio G, Tsubone H, Sant’Ambrogio FB (1995) Sensory information from the upper airway: role in the control of breathing. Respir Physiol 102:1–16

    Article  CAS  Google Scholar 

  26. Kuna ST, Sant’Ambrogio G (1991) Pathophysiology of upper airway closure during sleep. JAMA 266:1384–1389

    Article  PubMed  CAS  Google Scholar 

  27. Mathew OP, Abu-Osba YK, Thach BT (1982) Influence of upper airway pressure changes on genioglossus muscle respiratory activity. J Appl Physiol 52:438–444

    PubMed  CAS  Google Scholar 

  28. Sant’Ambrogio FB, Mathew OP, Clark WD, Sant’Ambrogio G (1985) Laryngeal influences on breathing pattern and posterior cricoarytenoid muscle activity. J Appl Physiol 58:1298–1304

    CAS  Google Scholar 

  29. Van Lunteren E, Van de Graaff WB, Parker DM, Mitra J, Haxhiu MA, Strohl KP, Cherniack NS (1984) Nasal and laryngeal reflex responses to negative upper airway pressure. J Appl Physiol 56:746–752

    Article  PubMed  Google Scholar 

  30. Chodosh PL (1977) Gastro-esophago-pharyngeal reflux. Laryngoscope 87:1418–1427

    Article  PubMed  CAS  Google Scholar 

  31. Sant’Ambrogio FB, Sant’Ambrogio G, Chung K (1998) Effects of HCl-pepsin laryngeal instillations on upper airway patency-maintaining mechanisms. J Appl Physiol 84:1299–1304

    Article  CAS  Google Scholar 

  32. Feinberg MJ, Knebl J, Tully J, Segall L (1990) Aspiration in the elderly. Dysphagia 5:61–71

    Article  PubMed  CAS  Google Scholar 

  33. Hagen J, Deitel M, Khanna RK, Lives R (1987) Gastroesophageal reflux in the massively obese. Int Surg 72:1–3

    PubMed  CAS  Google Scholar 

  34. Nebel OT, Fornes MS, Castell DO (1976) Symptomatic gastroesophageal reflux: incidence and precipitating factors. Am J Dig Dis 21:953–956

    Article  PubMed  CAS  Google Scholar 

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© 1999 Springer-Verlag Italia

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Sant’Ambrogio, G., Sant’Ambrogio, F.B. (1999). Pathophysiological Determinants of Gastroesophageal Reflux, and the Role of Esophageal and Airway Receptors. In: Dal Negro, R.W., Allegra, L. (eds) Pneumological Aspects of Gastroesophageal Reflux. Springer, Milano. https://doi.org/10.1007/978-88-470-2147-1_3

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  • DOI: https://doi.org/10.1007/978-88-470-2147-1_3

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-0049-0

  • Online ISBN: 978-88-470-2147-1

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