Esophagogastric Junction Morphology and Distal Esophageal Acid Exposure

Akimoto, Shunsuke; Singhal, Saurabh; Masuda, Tomoyuki; Yamamoto, Se Ryung; Svetanoff, Wendy Jo; Mittal, Sumeet K.

doi:10.1007/s10620-016-4331-y

Cited by 19 publications

(10 citation statements)

References 19 publications

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“…LES‐CD separation should be scored as the distance between the center of the CD and LES signal during inspiration, unless obscured in which case the LES position should be scored at expiration (Strong Recommendation). The EGJ complex should be defined based on LES‐CD separation and location of the RIP. (Low GRADE, Conditional Recommendation) 86–92 …”

Section: Esophagogastric Junction Metricsmentioning

confidence: 99%

“…• The EGJ complex should be defined based on LES-CD separation and location of the RIP. (Low GRADE, Conditional Recommendation) [86][87][88][89][90][91][92] As for EGJ morphology, it was acknowledged that there were three subtypes: 1) normal with the CD superimposed on the LES and the RIP localizing proximal to the complex; 2) LES-CD separation with the RIP localized proximal to the CD; and 3) LES-CD separation with the RIP localized proximal to the LES. However, there was no consensus regarding the subtype classification scheme (I, II, III vs A, C, B) and both versions were deemed acceptable ( Figure S4).…”

Section: Additional Considerations For Ineffective Esophageal Motilitymentioning

confidence: 99%

See 1 more Smart Citation

Esophageal motility disorders on high‐resolution manometry: Chicago classification version 4.0^©

Yadlapati

Kahrilas

Fox

et al. 2020

Neurogastroenterology Motil

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429

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Chicago Classification v4.0 (CCv4.0) is the updated classification scheme for esophageal motility disorders using metrics from high‐resolution manometry (HRM). Fifty‐two diverse international experts separated into seven working subgroups utilized formal validated methodologies over two‐years to develop CCv4.0. Key updates in CCv.4.0 consist of a more rigorous and expansive HRM protocol that incorporates supine and upright test positions as well as provocative testing, a refined definition of esophagogastric junction (EGJ) outflow obstruction (EGJOO), more stringent diagnostic criteria for ineffective esophageal motility and description of baseline EGJ metrics. Further, the CCv4.0 sought to define motility disorder diagnoses as conclusive and inconclusive based on associated symptoms, and findings on provocative testing as well as supportive testing with barium esophagram with tablet and/or functional lumen imaging probe. These changes attempt to minimize ambiguity in prior iterations of Chicago Classification and provide more standardized and rigorous criteria for patterns of disorders of peristalsis and obstruction at the EGJ.

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Section: Esophagogastric Junction Metricsmentioning

confidence: 99%

Section: Additional Considerations For Ineffective Esophageal Motilitymentioning

confidence: 99%

Esophageal motility disorders on high‐resolution manometry: Chicago classification version 4.0^©

Yadlapati

Kahrilas

Fox

et al. 2020

Neurogastroenterology Motil

Self Cite

658

429

View full text Add to dashboard Cite

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“…8,9 Studies over the years have shown that a hiatal hernia, especially >3 cm, is associated with the most severe reflux. [10][11][12] Attention to the presence of these abnormalities is crucial to management decisions, especially regarding surgical intervention after eradication of Barrett's tissue.…”

Section: Underlying Pathophysiology Of Gerdmentioning

confidence: 99%

Reflux Control After Barrett’s Esophagus Ablation

Mittal

Baboli

Bremner

2021

Foregut: The Journal of the American Foregut Society

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Esophageal adenocarcinoma (EAC) is difficult to treat and carries a poor prognosis. Barrett’s esophagus, which develops from long-standing gastroesophageal reflux disease is the only known precursor to EAC. Endoscopic eradication therapy is a major advancement in the treatment of dysplastic Barrett’s esophagus and early EAC; however, failure to eradicate disease and a high rate of recurrence with risk of progression currently remain unacceptably high with the use of acid suppressive medication for reflux. Herein, we describe the physiology of gastroesophageal reflux and review the current literature on endoscopic eradication therapy for Barret’s esophagus. We summarize that antireflux surgery for reflux control as an adjunct to endoscopic eradication therapy may decrease the need for multiple endoscopic sessions (to achieve eradication), decrease the risk for recurrence/progression, and potentially decrease the need for surveillance.

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“…It is a quite old finding from animal [9] and human [10] studies that the crura of the diaphragm play an important role in closure of the lower esophagus [11]. Especially a dissociation of the lower esophageal sphincter from the position of the diaphragmatic crura as seen in hiatal hernia seems to be an important mechanism for gastroesophageal reflux [12,13]. It is straightforward to hypothesize that regular training of the striated muscle diaphragm can improve present reflux symptoms or may reduce the prevalence of GERD.…”

Section: Introductionmentioning

confidence: 99%

The “Aachen sings” study (“Aachen choir engagement study into GERD symptoms”): moderate singing and breathing exercises in a choir reduce reflux symptoms – a cohort study in non-specialist choristers

Dietrich

Kottmann²,

Labenz

et al. 2019

Z Gastroenterol

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Background The influence of singing activities and breathing exercises on the presence of gastroesophageal reflux disease (GERD) symptoms is not clear. While an Austrian study found symptom reduction, an Italian study showed more symptoms in professional opera choristers. These contradictory results may be due to differential intensity of the singing exercises. We therefore developed a questionnaire to investigate the presence of GERD typical symptoms and defined GERD in nonprofessional choristers with moderate singing activity and breathing exercises and compared the results to those from related non-singing control persons. Methods 434 actively engaged lay-choir persons and 310 non-singing friends or relatives answered questions in a questionnaire regarding basic data, singing habits, GERD symptoms, and past or present diagnostic events and medications. Results Non-singing control persons experienced more frequently heartburn (1.1 ± 4.1 vs. 0.5 ± 1.2 episodes/week, p = 0.001) and acid regurgitation (0.9 ± 4.1 vs. 0.5 ± 1.3 episodes/week, p < 0.001) and had more often already received the diagnosis of GERD (16.8 % vs. 10.4 %, p = 0.011). From the persons without known GERD, members of the control cohort more often fulfilled the simplified diagnostic criteria of GERD (14.3 % vs. 5.1 %, p < 0.001). A multivariate analysis identified non-singing, high body mass index, and smoking as significant risk factors for the presence of GERD symptoms. Conclusion The frequency of reflux symptoms and GERD is probably still increasing. Moderate singing activities and breathing exercises seem to be helpful in avoiding reflux symptoms such as heartburn and acid regurgitation.

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Esophagogastric Junction Morphology and Distal Esophageal Acid Exposure

Abstract: A subset of patients with >2-cm LES-CD separation (type IIIb) maintain a physiological intra-abdominal location of the EGJ and are less likely to have reflux. A LES-CD ≥ 3 cm seems to discern a hiatus hernia of clinical significance.

Cited by 19 publications

References 19 publications

Esophageal motility disorders on high‐resolution manometry: Chicago classification version 4.0^©

Esophageal motility disorders on high‐resolution manometry: Chicago classification version 4.0^©

Reflux Control After Barrett’s Esophagus Ablation

The “Aachen sings” study (“Aachen choir engagement study into GERD symptoms”): moderate singing and breathing exercises in a choir reduce reflux symptoms – a cohort study in non-specialist choristers

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Esophagogastric Junction Morphology and Distal Esophageal Acid Exposure

Abstract: A subset of patients with >2-cm LES-CD separation (type IIIb) maintain a physiological intra-abdominal location of the EGJ and are less likely to have reflux. A LES-CD ≥ 3 cm seems to discern a hiatus hernia of clinical significance.

Cited by 19 publications

References 19 publications

Esophageal motility disorders on high‐resolution manometry: Chicago classification version 4.0©

Esophageal motility disorders on high‐resolution manometry: Chicago classification version 4.0©

Reflux Control After Barrett’s Esophagus Ablation

The “Aachen sings” study (“Aachen choir engagement study into GERD symptoms”): moderate singing and breathing exercises in a choir reduce reflux symptoms – a cohort study in non-specialist choristers

Contact Info

Product

Resources

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Esophageal motility disorders on high‐resolution manometry: Chicago classification version 4.0^©

Esophageal motility disorders on high‐resolution manometry: Chicago classification version 4.0^©