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Our hypothesis was that rumination syndrome is associated with gastric sensory and motor dysfunction. We studied gastric and somatic sensitivity, reflex relaxation of the lower esophageal sphincter (LES), and gastric compliance and accommodation postprandially and postglucagon. A barostatically controlled gastric bag and esophageal manometry were used to compare gastric sensorimotor functions and LES relaxation to gastric distension in 12 patients with rumination syndrome and 12 controls. During bag distensions, patients had greater nausea, bloating, and aggregate score, but not pain, compared with controls (P < 0.05). At 4 and 8 mmHg gastric distension, LES tone reduction was greater in patients than in controls (P < 0.05). Gastric compliance, accommodation to a standard meal, and response to glucagon were not different in patients and controls; however, 6 of 12 patients had no gastric accommodation; the latter patients had significantly greater pain perception during distension (P < 0.05) but normal somatic sensitivity compared with healthy controls. Rumination syndrome is characterized by higher gastric sensitivity and LES relaxation during gastric distension. A subgroup of patients also had absent postprandial accommodation.

Our aims were to measure antral axial forces in patients with suspected upper gut dysmotilities and to compare the number of antral contractions detected by an axial force catheter and by manometric sensors in the distal antrum and pylorus. Fifteen patients (2 men, 13 women; mean age 42 years) underwent studies for 3 hr fasting, 2 hr postprandially, and up to 60 min after intravenous erythromycin (3mg/kg). Seven patients had gastroparesis or chronic intestinal pseudoobstruction, five functional disease, and three subacute obstruction. Postprandially, the number of peaks detected by the two methods was not significantly different; however, after erythromycin, the axial catheter detected more contractions (P = 0.02). Erythromycin significantly increased the number of postprandial axial forces (from 1.2 +/- 0.3/min to 2.5 +/- 0.3/min, P < or = 0.01) in the whole group and in the organic dysmotility group (P = 0.01). Erythromycin significantly increases the number of axial forces in functional and organic upper gut dysmotilities, but the axial force catheter is not advantageous over manometry for postprandial measurements of antral motility.

We evaluated the relationship between gastroesophageal (GE) reflux and chronic cough using prolonged pH monitoring and the standard acid reflux study in a retrospective case review. Ten patients were referred to our clinical esophageal laboratory for prolonged pH monitoring to determine whether GE reflux was the cause of chronic cough. In addition, we report one patient referred for a standard acid reflux test as a clear example of spontaneous cough inducing GE reflux. Of the 10 patients having prolonged pH monitoring, 182 of 221 (80.9 +/- 4.6%) of cough episodes had no correlation with GE reflux (p = 0.0001). Of those cough episodes that appeared to be related to GE reflux, 27 of 39 (69.2 +/- 11.7%) occurred before GE reflux and 12/39 (30.8 +/- 10.3%) occurred after GE reflux (p = 0.06). In the single patient GE reflux after spontaneous cough occurred five of seven times during a standard acid reflux test. In our series, cough and reflux were not related in the majority of episodes. Where there was a relationship, it appeared that the cough preceded GE reflux twice as often as reflux preceded cough. We conclude that GE reflux does not appear to be a frequent cause of chronic cough.