In healthy subjects, the rate of acid reflux during transient lower esophageal sphincter relaxations (TLESRs) is more frequent at the proximal margin of the L ES. In this study, we investigated the hypothesis that the rate of acid reflux a t the proximal margin of LES during TLESRs is similar in reflux disease to that in healthy subjects. Concurrent esophageal manometry and pH monitoring were perf ormed in the sitting position for 3 hr after a standard meal in 10 patients with reflux disease and 10 agematched healthy controls. The rate of TLESRs in patien ts with reflux disease (5.0/hr [3.3-6.7]; median [interquartile range])-was si milar to that of controls (4.5/hr [3.7-5.7]). The incidence of acid reflux 7 cm above the LES during TLESRs in patients (48.1%[27.2-71.4%])was significantly higher than that in controls (10.9%[0.0-18.8%]) but there was no difference 2 cm above the LES (75.0 [69.2-87.5] vs. 74.3 [55.5-90.0%]). The rate of TLES Rs and the incidence of acid reflux during TLESRs are not increased in reflux disease. These findings, therefore, indicat e that reflux disease is not a disorder of TLESRs and relates more to the proxim al extent of the refluxate.
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