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.