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Cycling, a manometric phenomenon due to repetitive episodes of gastroesophageal reflux and clearance

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Abstract

We studied intraesophageal pressure changes in patients with symptoms of gastroesophageal reflux and an abnormal 24-hr pH monitoring record (N=52). Our method was simultaneous esophageal manometry and pH monitoring. We observed a three-component esophageal manometric sequence (EMS). When this sequence recurred over and over, we termed this phenomenon “cycling.” We found cycling in 35% of the patients (18/52). Those with cycling had lower basal LES pressures, more acid exposure, and an increased incidence of endoscopic esophagitis. That cycling resulted from repeated reflux events and their esophageal clearance was documented by scintigraphy during simultaneous manometry and pH monitoring (N=7 patients). Cycling was found on the routine esophageal manometry record of 25% of symptomatic patients (N=112) with an abnormal 24-hr pH score. In conclusion, cycling represents an esophageal manometric phenomenon due to repetitive reflux events. Its recognition during esophageal manometry may denote a severe reflux diathesis.

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Authors and Affiliations

  1. Gastroenterology Service, Department of Medicine, Walter Reed Army Medical Center, Washington, DC

    Steven S. Shay MD, Col MC USA, Douglas Eggli MD, German Oliver MD, David A. Peura MD & Lawrence F. Johnson MD

  2. Nuclear Medicine Service, Department of Radiology, Walter Reed Army Medical Center, Washington, DC

    Steven S. Shay MD, Col MC USA, Douglas Eggli MD, German Oliver MD, David A. Peura MD & Lawrence F. Johnson MD

  3. Digestive Diseases Division, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland

    Steven S. Shay MD, Col MC USA, Douglas Eggli MD, German Oliver MD, David A. Peura MD & Lawrence F. Johnson MD

Authors
  1. Steven S. Shay MD, Col MC USA
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  2. Douglas Eggli MD
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  3. German Oliver MD
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  4. David A. Peura MD
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  5. Lawrence F. Johnson MD
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The opinions and assertions contained herein are the private views of the authors and are not to be construed as official policy or as reflecting the views of the Department of the Army or the Department of Defense.

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Shay, S.S., Eggli, D., Oliver, G. et al. Cycling, a manometric phenomenon due to repetitive episodes of gastroesophageal reflux and clearance. Digest Dis Sci 34, 1340–1348 (1989). https://doi.org/10.1007/BF01538066

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  • DOI: https://doi.org/10.1007/BF01538066

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