Gastroesophageal dynamics during immersion in water to the neck

Abstract

This investigation was undertaken to study the effect of hydrostatic pressure on gastroesophageal dynamics during immersion in thermoneutral water to the neck. In 5 healthy male subjects (normal end-expiratory), gastric pressure (PG), esophageal pressure (PE), location and pressure of distal esophageal sphincter (des), location of respiratory inversion point (RIP), and gastroesophageal pH gradient were measured standing in air (A), standing in water to the neck (B), and standing in air with abdominal compression (C). The pressure was measured with a Honeywell esophageal catheter (model 31) with built-in pressure transducer. A Beckman stomach pH electrode (no. 39042) was positioned adjacent to the pressure transducer. PG increased from 4.6 +/- 0.6 (SE) mmHg in A to nearly 20 mmHg in B and C, while PE increased from -6.0 +/- 0.8 mmHg in A to -0.8 +/- 1.0 and -3.4 +/- 0.9 mmHg in B and C, respectively. However, PDES was always 11-15 mmHg higher than PG. The superior limit of DES was displaced cephalad by indicating a stretching of DES and a shortening of the esophagus. Qualitatively similar findings were obtained in C. In all experiments, the esophageal pH remained above 6, and no alteration in the amplitude of primary peristaltic waves was seen. It is concluded that a head-out immersion with increased gastroesophageal pressure gradient predisposes to gastric reflux in the absence of a competent DES mechanism.