Relationship between acceleration of gastric emptying and oesophageal acid exposure in patients with endoscopy-negative gastro-oesophageal reflux disease

Objective. A delay in gastric emptying has been reported in patients with gastro-oesophageal reflux disease (GORD), but its role in increasing the number of reflux episodes is still debated. The aim of this study was to assess the relationship between acceleration of gastric emptying and gastro-oesophageal reflux in patients with endoscopy-negative GORD and pathological oesophageal acid exposure. Material and methods. Twelve patients (7 M, age range 24 - 65 years) underwent 6-h postprandial (2.1 MJ meal) combined gastric emptying by real-time ultrasonography and intra-oesophageal pH monitoring after cisapride (20 mg b.i.d.) and placebo for 3 days, on two separate occasions at least 7 days apart in double-blind randomized order. Gastric emptying after placebo was also measured in 12 healthy volunteers (7M, age range 25-54 years). Results. In the patients' group, the area under the emptying time curve was greater (p < 0.01), and half and total emptying times prolonged (p < 0.01) compared to the healthy subjects, 115 min (mean) +/- 6 (SEM) versus 86 +/- 6 and 232 min +/- 16 versus 160 +/- 7, respectively. Cisapride accelerated both half- and total gastric emptying (p < 0.02): -22 min (mean); -10 to -34 (95% CI) and -48 min; - 10 to - 85, respectively, decreased both percentage of time at pH < 4 (p < 0.01) and number of reflux episodes (p < 0.05). However, no relationship was found between changes in gastric emptying and in the reflux variables by linear regression analysis (R-2 < 0.005). Conclusion. The emptying rate of the whole stomach is not a major determinant of gastro-oesophageal reflux.