Effect of hyperglycemia on triggering of transient lower esophageal sphincter relaxations
Abstract
Acute changes in blood glucose concentration have major effects on gastrointestinal motor function. Patients with diabetes mellitus have an increased prevalence of gastroesophageal reflux. Transient lower esophageal sphincter (LES) relaxation (TLESR) is the most common sphincter mechanism underlying reflux. The aim of this study was to investigate the effect of acute hyperglycemia on triggering TLESRs evoked by gastric distension in healthy volunteers. TLESRs were stimulated by pressure-controlled and volume-controlled (500 ml) gastric distension using an electronic barostat and performed on separate days. On each day, esophageal manometry was performed in the sitting position during gastric distension for 1 h under euglycemia (5 mM), and either marked hyperglycemia (15 mM) or physiological hyperglycemia (8 mM) in randomized order was maintained by a glucose clamp. Marked hyperglycemia doubled the rate of TLESRs in response to both pressure-controlled [5 (3-10.5, median or interquartile range) to 10 (9.5-14.5) per hour, P < 0.02] and volume-controlled [4 (2.5-7.5) to 10.5 (7-12.5) per hour, P < 0.02] gastric distension but had no effect on basal LES pressure. Physiological hyperglycemia had no effect on the triggering of TLESRs or basal LES pressure. In healthy human subjects, marked hyperglycemia increases the rate of TLESRs. Increase in the rate of TLESRs is independent of proximal gastric wall tension. Mechanisms underlying the effect remain to be determined. Hyperglycemia may be an important factor contributing to the increased esophageal acid exposure in patients with diabetes mellitus.
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There is evidence that the increase in reflux esophagitis in type II diabetes occurs via elevated oxidative stress.
“There is also evidence that the increase in reflux esophagitis in type II diabetes occurs via elevated oxidative stress [54], [55].”
From Cytoprotective Effects of Hydrogen Sulfide in Novel Rat Models of Non-Erosive Esophagitis (2014) · cites this paper as [55]
Hyperglycemia triggers relaxation of the lower esophageal sphincter, thereby promoting acid reflux.
“Hyperglycemia triggers relaxation of the lower esophageal sphincter [55], thereby promoting acid reflux.”
From Cytoprotective Effects of Hydrogen Sulfide in Novel Rat Models of Non-Erosive Esophagitis (2014) · cites this paper as [55]
Over-consumption of sugars contributes to esophageal motor dysfunction, and in turn to the increase in acid reflux and esophagitis in individuals with metabolic disorders.
“There is growing evidence that over-consumption of sugars contributes to esophageal motor dysfunction [54], [55], and in turn to the increase in acid reflux and esophagitis in individuals with metabolic disorders.”
From Cytoprotective Effects of Hydrogen Sulfide in Novel Rat Models of Non-Erosive Esophagitis (2014) · cites this paper as [55]
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Cytoprotective Effects of Hydrogen Sulfide in Novel Rat Models of Non-Erosive Esophagitis
Zayachkivska, O., Havryluk, O., Hrycevych, N., Bula, N., Grushka, O., & Wallace, J. L. (2014) · PLoS ONE · doi:10.1371/journal.pone.0110688 · Cited by 34 · see citing works
“Hyperglycemia triggers relaxation of the lower esophageal sphincter [55], thereby promoting acid reflux.”
BackgroundHershcovici, T., Jha, L. K., Gadam, R., Cui, H., Gerson, L., Thomson, S., & Fass, R. (2012) · Journal of Clinical Gastroenterology · doi:10.1097/mcg.0b013e31824e139b · Cited by 18 · see citing works
- Authors
- Zhang, Q., Horowitz, M., Rigda, R., Rayner, C., Worynski, A., & Holloway, R. H.
- Affiliations
- Royal Adelaide Hospital (AU)
- Venue
- American Journal of Physiology-Gastrointestinal and Liver Physiology
- Publisher
- American Physiological Society
- Published
- 2004-05
- Volume
- 286
- Issue
- 5
- Pages
- G797-G803
- ISSN
- 0193-1857 (ISSN-L)
- 1522-1547
- OpenAlex
- W2003058178
- Cited by
- 30
- References
- 62
- Citations by year
- 2021: 2 · 2020: 2 · 2019: 2 · 2017: 4 · 2016: 1 · 2015: 3 · 2014: 3 · 2013: 2 · 2012: 3
- FWCI
- 1.31
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Physiology-Gastrointestinal and Liver Physiology (publishedVersion)
- PubMed (publishedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastroesophageal reflux and treatments
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Medicine › Surgery › Helicobacter pylori-related gastroenterology studies
- Keywords
- hyperglycemia, transient lower esophageal sphincter relaxations, gastroesophageal reflux, gastric distension, lower esophageal sphincter pressure, glucose clamp, diabetes mellitus, esophageal acid exposure
- MeSH terms
- Adult, Catheterization, Esophagogastric Junction, Female, Humans, Hyperglycemia, Male, Manometry, Middle Aged, Muscle Relaxation, Glucose Clamp Technique
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