Heartburn Remedies

🔥+ Heartburn Remedies 04 Jun 2020 The pain is often worse after eating, in the evening, or when lying down or bending over. ... Most people can manage the discomfort of heartburn on their own with ... eating and may occur at night; Pain that worsens when lying down or bending ... acid can flow back up into your esophagus (acid reflux) and cause heartburn.Find out about the symptoms of GERD and how they affect sleep. ... (usually heartburn or coughing and choking) while sleeping or attempting to sleep. ... Sometimes GERD can cause serious complications including inflammation of the ... you can make to minimize GERD include avoiding fats, onions, chocolate and alcohol.

Heartburn Remedies Items that people with GERD are often advised to avoid include: ... well as fatty cuts of meat and processed meats like hot dogs and luncheon meat. ... In addition to changing what you eat, your doctor may ask you to change ...

Can Gerd Make You Dizzy
World J Gastroenterol. 2010 Feb 28; 16(8): 987–991.
Published online 2010 Feb 28. doi: 10.3748/wjg.v16.i8.987
PMCID: for 1 last update 04 Jun 2020 PMC2828604PMC2828604
PMID: 20180238
Koichi Yoshida, Kenji Furuta, Shunji Ohara, Terumi Morita, Takashi Tanimura, Shuji Nakata, Masaharu Miki, Kenji Koshino, Yoshikazu Kinoshita, Second Department of Internal Medicine, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo-shi, Shimane 693-8501, Japan
Kyoichi Adachi, Department of Clinical Nursing, Shimane University Faculty of Medicine, Enya-cho, Izumo-shi, Shimane 693-8501, Japan
Author contributions: Yoshida K and Furuta K contributed equally to this work; Yoshida K, Furuta K, Adachi K and Kinoshita Y designed the research; Yoshida K, Furuta K, Adachi K, Ohara S, Morita T, Tanimura T, Nakata S, Miki M, Koshino K and Kinoshita Y performed the research; Yoshida K, Furuta K, Adachi K and Kinoshita Y analyzed the data and wrote the manuscript.

Correspondence to: Kenji Furuta, MD, PhD, Second Department of Internal Medicine, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo-shi, Shimane 693-8501, Japan. [email protected]

Telephone: +81-853-202190 Fax: +81-853-202187

Received 2009 Oct 29; Revised 2009 Dec 9; Accepted 2009 Dec 16.
Copyright ©2010 Baishideng. All rights reserved.
This article has been cited by other articles in PMC.

Abstract

AIM: To clarify the effects of anti-hypertensive drugs on esophageal contraction and determine their possible relationship with gastro-esophageal reflux disease.

METHODS: Thirteen healthy male volunteers were enrolled. Esophageal body peristaltic contractions and lower esophageal sphincter (LES) pressure were measured using high resolution manometry. All subjects were randomly examined on four separate occasions following administrations of nifedipine, losartan, and atenolol, as well as without any drug administration.

RESULTS: Peristaltic contractions by the esophageal body were separated into three segments by two troughs. The peak peristaltic pressures in the mid and lower segments of the esophageal body under atenolol administration were significantly higher than those without medication in a supine position. On the other hand, peristaltic pressures under nifedipine administration were lower than those observed without drug administration. Losartan did not change esophageal body peristalsis. Atenolol elevated LES pressure and slowed peristaltic wave transition, while the effects of nifedipine were the opposite.

CONCLUSION: Among the anti-hypertensive drugs tested, atenolol enhanced esophageal motor activity, which was in contrast to nifedipine.

Keywords: Anti-hypertensive drug, High-resolution manometry, Lower esophageal sphincter, Esophageal body contraction, Calcium-channel blocker, β1 blocker

INTRODUCTION

Impaired esophageal motor functions, such as decreased lower esophageal sphincter (LES) pressure and weak esophageal body peristalsis, are the main causes of gastro-esophageal reflux disease (GERD)[1,2]. Conventional manometry has demonstrated that several different drugs impair esophageal motor function. It has also been speculated that they increase esophageal acid exposure[3]. Nifedipine, a calcium-channel blocker, was shown to reduce LES pressure, as well as the amplitude and duration of esophageal peristaltic contractions, in healthy subjects. It also increased esophageal acid exposure time[4-6]. In addition, candesartan, an angiotensin II (AngII) receptor antagonist, was reported to reduce the amplitude of swallow-induced peristaltic contractions and LES pressure[7]. In contrast, atenolol, a catecholamine β receptor antagonist, was found to inhibit the relaxation of esophageal smooth muscle induced by catecholamine β stimulation[8].

Recent studies using high-resolution manometry revealed that esophageal body peristalsis was composed of a chain of three contraction segments separated by two troughs[9-11]. Conventional esophageal manometry techniques are not sensitive enough to detect those three separate contraction segments[12-14]. The uppermost (first) peristaltic segment represents the skeletal muscle component of the esophageal body, while the lowest (third) segment represents the smooth muscle component. In the middle (second) segment, the muscle tissue is considered to shift from skeletal to smooth type[9-13]. Therefore, neuromuscular contraction control might be different between the three segments. In addition, the second segment was reported to be more responsive to cholinergic stimulation, whereas the third has been demonstrated to be under stronger control of non-cholinergic and non-adrenergic neurons[15-17]. Therefore, the various drugs reported to have for 1 last update 04 Jun 2020 an influence on esophageal motor function might have different effects on each of the segments of the esophageal body, though the effects of anti-hypertensive drugs on these segments have not been investigated.Recent studies using high-resolution manometry revealed that esophageal body peristalsis was composed of a chain of three contraction segments separated by two troughs[9-11]. Conventional esophageal manometry techniques are not sensitive enough to detect those three separate contraction segments[12-14]. The uppermost (first) peristaltic segment represents the skeletal muscle component of the esophageal body, while the lowest (third) segment represents the smooth muscle component. In the middle (second) segment, the muscle tissue is considered to shift from skeletal to smooth type[9-13]. Therefore, neuromuscular contraction control might be different between the three segments. In addition, the second segment was reported to be more responsive to cholinergic stimulation, whereas the third has been demonstrated to be under stronger control of non-cholinergic and non-adrenergic neurons[15-17]. Therefore, the various drugs reported to have an influence on esophageal motor function might have different effects on each of the segments of the esophageal body, though the effects of anti-hypertensive drugs on these segments have not been investigated.

The aim of this study was to clarify the effects of three different types of anti-hypertensive drugs on the three different segments of esophageal body contractions using a recently developed high-resolution manometric system.

MATERIALS AND METHODS

Heartburn Remedies Acid Reflux (⭐️ Foods That Fight Hearbturn) | Heartburn Remedies What Causes Heartburnhow to Heartburn Remedies for Subjects

Heartburn Remedies 10 Remedies (👍 Home Remedies For) | Heartburn Remedies GERDhow to Heartburn Remedies for Thirteen male volunteers were recruited for this study (mean age: 34.7 years). None of the subjects had upper gastrointestinal symptoms, a history of upper gastrointestinal surgery, or were taking medications known to influence esophageal motor function. Written informed consent was obtained from each volunteer before starting the study, which was carried out in accordance with the Declaration of Helsinki. This study was approved by the Ethics Committee of Shimane University.

Study protocol

We evaluated esophageal motor function under separate administrations of nifedipine, a calcium-channel blocker, atenolol, a catecholamine β receptor antagonist, and losartan, an angiotensin II receptor antagonist. All subjects were examined four separate times after an overnight fast, with the following administrations; (1) without medication, (2) 10 mg of nifedipine, (3) 50 mg of losartan, and (4) 50 mg of atenolol, which were performed randomly in each case. The administrations of nifedipine, losartan, and atenolol were given at 1, 4, and 4 h, respectively, before performing the esophageal motor function test, to match the maximal blood concentration of each drug with the examination period. In addition, all subjects were instructed to drink 200 mL of water at 4 h and 1 h before each esophageal motor function test.

Esophageal manometry

We performed high-resolution manometric tests using a ManoScan 360™ (Sierra Scientific Instruments, Inc., California)[18]. The manometric catheter used with this system is 4.2 mm in diameter and has 36 intraluminal pressure transducers at 1-cm intervals, which are used to measure peristaltic pressure in the upper esophageal sphincter (UES) to LES simultaneously and continuously. Before performing esophageal pressure measurements, transducers were calibrated at 0 and 100 mmHg using externally applied pressure, according to the manufacturer’s instructions. The manometric catheter was inserted in a transnasal manner using 2% lidocaine jelly (Xylocaine jelly; AstraZeneka Co., Osaka, Japan), LES pressure (LESP) was then measured in a sitting position during a 5-min resting period. Next, esophageal body peristaltic function in the sitting position was examined by swallowing 5 mL of room temperature water, which was repeated at 2-min intervals until five recordings of complete esophageal peristalsis were obtained. After finishing the tests in the sitting position, they were repeated in a supine position. The peristaltic contractions in the esophageal body were divided into three different segments (segments 1, 2, and 3 from oral to anal) separated by two troughs, as shown in Figure Figure1.Figure1.1. LESP and peak intraesophageal contraction pressure in the three segments of the esophageal body were analyzed using ManoView™ analysis software (Sierra Scientific Instruments, Los Angeles, CA). Peristaltic contraction velocity between 5 and 15 cm above LES was also determined.

Peristaltic contractions in the esophageal body were the 1 last update 04 Jun 2020 divided into three different segments (segments 1, 2, and 3, from oral to anal) by two troughs. UES: Upper esophageal sphincter; LES: Lower esophageal sphincter.Peristaltic contractions in the esophageal body were divided into three different segments (segments 1, 2, and 3, from oral to anal) by two troughs. UES: Upper esophageal sphincter; LES: Lower esophageal sphincter.

Statistical analysis

Statistical analysis of paired data was performed using a Wilcoxon signed rank test. All calculations were done using the Stat View 5.0 software package (Abacus Concepts Inc., Berkeley, CA, USA) for Macintosh. Differences at P < 0.05 were considered to be statistically significant.

RESULTS

All 13 subjects completed the study protocol without any adverse events. LESP values in the supine position were significantly higher than those in the sitting position, both with and without administration of the drugs investigated in this study. Furthermore, LESP with the administration of nifedipine tended to be lower, while that under the administration of atenolol tended to be higher, as compared to the control (Table (Table11).

Table 1

Resting LES pressure with and without the 1 last update 04 Jun 2020 administration of anti-hypertensive drugs (mean ± SE)Resting LES pressure with and without administration of anti-hypertensive drugs (mean ± SE)

No medication
Nifedipine
Losartan
Atenolol
SittingSupineSittingSupineSittingSupineSittingSupine
LESP (mmHg)12.8 ± 2.419.8 ± 1.5a10.2 ± 1.916.7 ± 1.7a12.4 ± 2.720.8 ± 2.1a15.8 ± 2.021.8 ± 2.4a
aSignificantly different in comparison with sitting (P < 0.05). LESP: Lower esophageal sphincter pressure.

The peak peristaltic pressures in the three segments of the esophageal body in the supine position were significantly higher than those in the sitting position, and also significantly increased from segment 1 to 3 (Table the 1 last update 04 Jun 2020 (Table2).(Table2).2). However, there was no difference in peak contraction pressure in segment 1 of the esophageal body with and without administration of the drugs. In contrast, peak contraction pressure in segments 2 and 3 with nifedipine administration tended to be lower than those without medication (Table (Table22 and Figure Heartburn Remedies Natural Remedies (👍 Stops Acid Reflux) | Heartburn Remedies Diet Changes Forhow to Heartburn Remedies for Figure2).Heartburn Remedies Naturally (👍 7 Ways To Relieve) | Heartburn Remedies Quick Reliefhow to Heartburn Remedies for 2). On the other hand, peak pressures in those segments under atenolol administration were higher than without medication (Table (Table22 and Figure Heartburn Remedies Symptoms (👍 Heartburn) | Heartburn Remedies Acidityhow to Heartburn Remedies for Figure2).2). Losartan did not significantly affect peak contraction pressures in the second and third segments (Table (Table2 the 1 last update 04 Jun 2020 22).

Table 2

Peak peristaltic pressure in three segments during esophageal body contractions with and without administration of antihypertensive drugs (mean ± SE)

No medication
Nifedipine
Losartan
Atenolol
SittingSupineSittingSupineSittingSupineSittingSupine
Segment 1 (mmHg)45.3 ± 12.972.4 ± 14.442.1 ± 10.177.4 ± 12.640.5 ± 10.577.5 ± 12.042.8 ± 8.279.3 ± 12.2
Segment 2 (mmHg)105.5 ± 10.7117.0 ± 12.383.7 ± 9.7109.5 ± 15.496.4 ± 17.3120.5 ± 34.9122.0 ± 15.6153.8 ± 12.4a
Segment 3 (mmHg)141.7 ± 15.2148.9 ± 31.6115.5 ± 20.6140.4 ± 9.8152.2 ± 27.9181.1 ± 31.9216.9 ± 39.4a246.5 ± 45.1a
aSignificantly different in comparison with no medication (P < 0.05).

Peak esophageal peristaltic pressures in the three segments with and without administration of drugs. A: Nifedipine; B: Atenolol. aP < 0.05 vs no medication.

Esophageal peristaltic velocity in the supine position tended to be lower than that in the sitting position. Furthermore, under the administration of nifedipine, it tended to be faster than that without medication. On the other hand, velocity with atenolol was significantly slower than the 1 last update 04 Jun 2020 that without medication (Table (Table33).Esophageal peristaltic velocity in the supine position tended to be lower than that in the sitting position. Furthermore, under the administration of nifedipine, it tended to be faster than that without medication. On the other hand, velocity with atenolol was significantly slower than that without medication (Table (Table33).

Heartburn Remedies Cure Your Acid Reflux (👍 GERD) | Heartburn Remedies Foods For Acid Refluxhow to Heartburn Remedies for Table 3

Velocity of esophageal peristalsis with and without administration of anti-hypertensive drugs (mean ± SE)

No medication
Nifedipine
Losartan
Atenolol
SittingSupineSittingSupineSittingSupineSittingSupine
Velocity (mm/s)4.9 ± 0.44.6 ± 0.35.1 ± 0.44.8 ± 0.24.8 ± 0.54.6 ± 0.44.7 ± 0.34.4 ± 0.2a
aSignificantly different in comparison with no medication (P < 0.05).

DISCUSSION

Calcium-channel blockers, such as nifedipine, inhibit the entry of calcium into smooth muscle cells of the arterial wall, and are widely used for treatment of patients with ischemic heart disease and hypertension[5]. Orally administered nifedipine was shown not only to decrease LESP in healthy subjects and patients with achalasia, but also reduced the amplitude and duration of esophageal peristaltic contractions in healthy subjects[4-6]. Ang II is the key mediator of the rennin-angiotensin system, which maintains extracellular fluid volume and electrolyte homeostasis, and also regulates vascular tone and blood pressure[19]. The physiological functions of Ang II are mediated specifically by the Ang II type 1 (AT1) and type 2 (AT2) receptors. Losartan, an AT1 receptor antagonist, was previously reported to reduce the amplitude of swallow-induced peristaltic esophageal contractions and LESP[7]. The catecholamine β-adrenoceptor is currently classified into β1, β2, and β3 subtypes, all of which are expressed in smooth muscle cells. Smooth muscle in the gastrointestinal tract is known to have the β1-adrenoceptor subtype and it has been shown that smooth muscle relaxes in response to β-adrenoceptor stimulation. In addition, atenolol, a β1 blocker, was reported to inhibit the relaxation of esophageal smooth muscle induced by β1[8]. These observations of the effects of nifedipine, losartan, and atenolol were obtained in studies that used conventional intraesophageal pressure monitoring systems. Those are able to determine intraesophageal pressure at some sites, but they are not sensitive enough to measure peristaltic contractions in the three different esophageal body segments[8,9].

Heartburn Remedies How To Get Rid Of (⭐️ Warnings) | Heartburn Remedies What To Eathow to Heartburn Remedies for Peristaltic contraction in segment 3 of the esophageal body is the strongest in amplitude and the most important factor for volume clearance of acidic refluxant from the stomach[20]. Therefore, to clarify the effects of the three anti-hypertensive drugs on the development of GERD, their effects on the three different segments, especially the lowest segment (segment 3) were investigated in the present study.

Heartburn Remedies Soothe The Pain (☑ Foods To Avoid) | Heartburn Remedies When To See A Doctorhow to Heartburn Remedies for We used high-resolution manometry to measure intraesophageal pressure in 36 different sites at the same time, while contractions in each of the three esophageal segments were separately measured[14]. As reported by other investigators using conventional manometry, nifedipine tended to decrease LESP, while atenolol increased it. Similarly, nifedipine tended to decrease the amplitude of peristaltic contractions in segment 3, while atenolol significantly increased it in both the sitting and supine positions. These observations fit well with previous reports that a regular administration of calcium antagonists for treatment of hypertension is a risk factor for the future occurrence of GERD. Interestingly, atenolol significantly elevated LESP and the peristaltic amplitude in the lower esophageal body (segment 3). Such atenolol-induced alterations of esophageal motor activity may prevent the development of GERD.

An interesting finding in our study was the reciprocal relationship between contraction amplitude and peristaltic velocity of the esophageal body. Factors that induce augmentation of peristaltic amplitude, such as atenolol administration and the supine position, were found to delay peristaltic velocity[21,22]. On the other hand, factors that caused a decrease in contraction amplitude, such as nifedipine administration and the sitting position, accelerated peristaltic contraction velocity[21,22]. Although the mechanisms by which these reciprocal phenomena occur are not clear, slowly progressing high amplitude peristalsis might be a more efficient peristaltic wave for propelling esophageal contents down to the stomach.

Another interesting finding was the lack of significant effect by losartan on esophageal motor activity, which differs from previous reports, though the reason is not clear. We used modern high-resolution measurements in the present study. Therefore, at least in healthy volunteers, we believe that the inhibiting effect of losartan on esophageal motor function is not clinically important.

In conclusion, of the anti-hypertensive drugs tested, atenolol enhanced esophageal for 1 last update 04 Jun 2020 motor activity, which was in contrast to a calcium antagonist.In conclusion, of the anti-hypertensive drugs tested, atenolol enhanced esophageal motor activity, which was in contrast to a calcium antagonist.

COMMENTS

Background

Nifedipine, a calcium-channel blocker, was shown to decrease lower esophageal sphincter pressure and increase esophageal acid exposure time, while atenolol, a β1 blocker, was shown to inhibit relaxation of the smooth muscle of the esophagus. However, the influence of these anti-hypertensive drugs on the segment of esophageal body contraction using high-resolution manometry was not fully investigated.

Research frontiers

Several reports have demonstrated that anti-hypertensive drugs affect the esophageal motor function and might facilitate gastroesophageal reflux. However, the details of the drug-induced impairment of esophageal motor function are not clear. This is the first published data concerning the use of high-resolution manometry to study the effects of anti-hypertensive drugs on the motor activity of the different segments of the esophageal body.

Innovations and breakthroughs

Previous data on the effect of anti-hypertensive drugs were obtained in studies that used conventional intraesophageal pressure monitoring systems. In this study, the authors observed esophageal body contraction using high-resolution manometry with 36 intraruminal transducers. The esophageal body was divided into three segments manometrically. Nifedipine and atenolol were found to affect motor activity only in the middle and lower segments of the esophagus. Anatomical differences in the contraction of the esophageal body during the administration of anti-hypertensive drugs were clarified for the first time.

Applications

By understanding the anatomical responses of the esophageal body motor activity to the administration of anti-hypertensive drugs, more appropriate selection of anti-hypertensive drugs for patients with gastro-esophageal reflux disease (GERD) will be facilitated.

Terminology

Nifedipine atenolol, and losartan are all drugs widely used for the treatment of hypertension. As both of hypertension and GERD are common diseases, the effects of anti-hypertensive drugs on the esophageal motor activity are important.

Peer review

This is a well-designed study with limited new information about drug effects on esophageal motility. The references are well selected and the discussion is good.

Footnotes

Heartburn Remedies 11 Foods That Help (🔴 Acid Reflux Every Day) | Heartburn Remedies 10 Drinkshow to Heartburn Remedies for Supported by The Grants-in-Aid from Science Research from the Ministry of Education, Culture, Sports, Science and Technology of Japan, No. 19590724

Heartburn Remedies Tips (☑ Home Remedy) | Heartburn Remedies Other Natural Remedieshow to Heartburn Remedies for Peer reviewer: Andrew Ukleja, MD, Assistant Professor, Clinical Assistant Professor of Medicine, Director of Nutrition Support Team, Director of Esophageal Motility Laboratory, Cleveland Clinic Florida, Department of Gastroenterology, 2950 Cleveland Clinic Blvd., Weston, FL 33331, United States

S- Editor Wang YR L- Editor Stewart GJ E- Editor Ma WH

References

1. Heartburn Remedies Acid Reflux (🔴 10 Drinks) | Heartburn Remedies GERD Diethow to Heartburn Remedies for Achem AC, Achem SR, Stark ME, DeVault KR. Failure of esophageal peristalsis in older patients: association with esophageal acid exposure. Am J for 1 last update 04 Jun 2020 Gastroenterol. 2003;98:35–39. [PubMed] [Google Scholar]Achem AC, Achem SR, Stark ME, DeVault KR. Failure of esophageal peristalsis in older patients: association with esophageal acid exposure. Am J Gastroenterol. 2003;98:35–39. [PubMed] [Google Scholar]
2. Boeckxstaens GE. Review article: the pathophysiology of gastro-oesophageal reflux disease. Heartburn Remedies Other Natural Remedies (👍 Best Home Remedies) | Heartburn Remedies Heartburn Home Remedieshow to Heartburn Remedies for Aliment Pharmacol for 1 last update 04 Jun 2020 Ther. Aliment Pharmacol Ther. 2007;26:149–160. [PubMed] [Google Scholar]
3. Bruley des Varannes S, Scarpignato C. Current trends in the management of achalasia. Dig Liver Dis. 2001;33:266–277.Dig Liver Dis. 2001;33:266–277. [PubMed] [Google Scholar]
4. Konrad-Dalhoff I, Baunack AR, Rämsch KD, Ahr G, Kraft H, Schmitz H, Weihrauch TR, Kuhlmann J. Effect of the calcium antagonists nifedipine, nitrendipine, nimodipine and nisoldipine on oesophageal motility in man. Eur J Clin Pharmacol. 1991;41:313–316. [PubMed] [Google Scholar]
5. Ishikawa H, Iwakiri K, Sugiura T, Kobayashi M. Effect of nifedipine administration (10 mg) on esophageal acid exposure time. J Gastroenterol. 2000;35:43–46. [PubMed] [Google Scholar]
6. Heartburn Remedies Tips (🔴 Nighttime) | Heartburn Remedies Diseasehow to Heartburn Remedies for Hamada A, Ishii J, Doi K, Hamada N, Miyazaki C, Hamada T, Ohwaki Y, Wada M, Nakashima K. Increased risk of exacerbating gastrointestinal disease among elderly patients following treatment with calcium channel blockers. J Clin Pharm the 1 last update 04 Jun 2020 Ther. J Clin Pharm Ther. 2008;33:619–624. [PubMed] [Google Scholar]
7. Casselbrant A, Edebo A, Wennerblom J, Lönroth H, Helander HF, Vieth M, Lundell L, Fändriks L. Actions by angiotensin II on esophageal contractility in humans. Gastroenterology. 2007;132:249–260. [PubMed] [Google Scholar]
8. Tanaka Y, Horinouchi T, Koike K. New insights into beta-adrenoceptors in smooth muscle: distribution of receptor subtypes and molecular mechanisms triggering muscle relaxation. Heartburn Remedies Acid Reflux Every Day (⭐️ Why) | Heartburn Remedies Nighttimehow to Heartburn Remedies for Clin Exp Pharmacol Physiol. 2005;32:503–514. [PubMed] [Google Scholar]
9. Clouse RE, Staiano A. Topography of the esophageal peristaltic pressure wave. Am J Physiol. 1991;Heartburn Remedies Heartburn Relief (⭐️ Acid Reflux) | Heartburn Remedies Diseasehow to Heartburn Remedies for 261:G677–G684. [PubMed] [Google Scholar]
10. Clouse RE, Alrakawi A, Staiano A. Intersubject and interswallow variability in topography of esophageal motility. Dig Dis the 1 last update 04 Jun 2020 Sci. Dig Dis Sci. 1998;43:1978–1985. [PubMed] [Google Scholar]
11. Ghosh SK, Janiak P, Schwizer W, Hebbard GS, Brasseur JG. Physiology of the esophageal pressure transition zone: separate contraction waves above and below. Am J Physiol Gastrointest Liver Physiol. 2006;290:G568–G576. [PubMed] [Google Scholar]
12. Clouse RE, Prakash C. Topographic esophageal manometry: an emerging clinical and investigative approach. Dig Dis. 2000;18:64–74. [PubMed] [Google Scholar]
13. Clouse RE, Staiano A, Alrakawi A, Haroian L. Application of topographical methods to clinical esophageal manometry. Am J Gastroenterol. 2000;95:2720–2730. [PubMed] [Google Scholar]Clouse RE, Staiano A, Alrakawi A, Haroian L. Application of topographical methods to clinical esophageal manometry. Am J Gastroenterol. 2000;95:2720–2730. [PubMed] [Google Scholar]
14. Wilson JA, Vela MF. New esophageal function testing (impedance, Bravo pH monitoring, and high-resolution manometry): clinical relevance. Curr Gastroenterol Rep. 2008;10:222–230. [PubMed] [Google Scholar]
15. Crist J, Gidda JS, Goyal RK. Intramural mechanism of esophageal peristalsis: roles of cholinergic and noncholinergic nerves. Proc Natl Acad Sci USA. 1984;81:3595–3599. [PMC free for 1 last update 04 Jun 2020 article][PMC free article] [PubMed] [Google Scholar]
16. Park H, Conklin JL. Neuromuscular control of esophageal peristalsis. Heartburn Remedies List Of (⭐️ Heartburn Naturally) | Heartburn Remedies Heartburnhow to Heartburn Remedies for Curr Gastroenterol Rep. 1999;1:186–197. [PubMed] [Google Scholar][Google Scholar]
17. Goyal RK, Chaudhury A. Physiology of normal esophageal motility. J Clin Gastroenterol. 2008;42:610–619. [PMC free article] [PubMed] [Google Scholar]
18. Pandolfino JE, Ghosh SK, Zhang Q, Jarosz A, Shah N, Kahrilas PJ. Quantifying EGJ morphology and relaxation with high-resolution manometry: a study of 75 asymptomatic volunteers. Heartburn Remedies How To (⭐️ 9 Home Remedies) | Heartburn Remedies 7 Natural GERDhow to Heartburn Remedies for Am J Physiol Gastrointest Liver Physiol. 2006;290:G1033–G1040. [PubMed] [Google for 1 last update 04 Jun 2020 Scholar][Google Scholar]
19. Spak E, Casselbrant A, Olbers T, Lönroth H, Fändriks L. Angiotensin II-induced contractions in human jejunal wall musculature in vitro. Heartburn Remedies Side Effects (☑ Acid Reflux) | Heartburn Remedies What Causes Heartburnhow to Heartburn Remedies for Acta Physiol (Oxf) 2008;193:181–190. [PubMed] [Google Scholar]
20. Murray JA, Clouse RE, Conklin JL. Components of the standard oesophageal manometry. Heartburn Remedies 10 Drinks (⭐️ Remedy Relief) | Heartburn Remedies Naturalhow to Heartburn Remedies for Neurogastroenterol Motil. 2003; for 1 last update 04 Jun 2020 1515:591–606. [PubMed] [Google the 1 last update 04 Jun 2020 Scholar][Google Scholar]
21. Iwakiri K, Sugiura T, Kotoyori M, Yamada H, Hayashi Y, Nakagawa Y, Kawakami A, Kobayashi M. Effect of body position on lower esophageal sphincter pressure. J Gastroenterol. 1999;34:305–309. [PubMed] [Google Scholar]
22. Tutuian R, Elton JP, Castell DO, Gideon RM, Castell JA, Katz PO. Effects of position on oesophageal function: studies using combined manometry and multichannel intraluminal impedance. Heartburn Remedies Acid Reflux (🔴 Best Practices) | Heartburn Remedies 9 Home Remedieshow to Heartburn Remedies for Neurogastroenterol Motil. 2003;15:63–67. [PubMed] Heartburn Remedies Heartburn (⭐️ How To Naturally Treat) | Heartburn Remedies Besthow to Heartburn Remedies for [Google Scholar]

Articles from World Journal of Gastroenterology are provided here courtesy of Baishideng Publishing Group Inc