Interaction of lower esophageal sphincter pressure and length of sphincter in the abdomen as determinants of gastroesophageal competence

O’Sullivan, Gerald C.; DeMeester, Tom R.; Joelsson, B.; Smith, R. B.; Blough, Richard R.; Johnson, Lawrence F.; Skinner, David B.

doi:10.1016/0002-9610(82)90127-1

Cited by 125 publications

(40 citation statements)

References 16 publications

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“…The segment of the LES that is exposed to intra-abdominal pressure has been shown to be an important determinant of the competence of the LES in preventing GER. 26,27 That the OSA groups had a greater intra-abdominal LES length suggests that OSA is associated with anatomical features which may be protective of GER. With regard to esophageal peristalsis, proximal peristaltic amplitude during liquid and viscous swallows was significantly higher in the obese OSA than the obese control group, however this was not significantly different from the non-obese OSA group.…”

Section: Discussionmentioning

confidence: 99%

Mechanism of Gastroesophageal Reflux in Obstructive Sleep Apnea: Airway Obstruction or Obesity?

Shepherd

Orr

2016

Journal of Clinical Sleep Medicine

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Study Objectives: This is the first study to compare reflux events during wake and sleep in obese and non-obese individuals with obstructive sleep apnea (OSA) and obese individuals without OSA. The primary aim of the study was to investigate any additive effect of OSA on gastroesophageal reflux (GER) above that of obesity. Methods: Twenty obese individuals (body mass index, BMI > 30 kg/m 2 ), 9 non-obese individuals (BMI < 30 kg/m 2 ) with moderate-to-severe OSA, and 17 obese control subjects (BMI > 30 kg/m 2 ) underwent high-resolution esophageal manometry, 24-h esophageal pH-impedance monitoring, and in-laboratory polysomnography. Results: Mean body mass index was 40 ± 6 and 27 ± 4 kg/m 2 for the obese and non-obese OSA groups, respectively, and 34 ± 5 kg/m 2 for the obese control group. Apnea-hypopnea index (AHI) was 50 ± 30 and 30 ± 25 per hour for the obese and non-obese OSA groups (p > 0.05), significantly higher than that of the obese control group (3 ± 3 per hour, p < 0.05). The two obese groups did not show any significant differences in the total number of acidic reflux events (41 ± 20 vs 28 ± 16); however, the obese OSA group had a greater number of acidic reflux events compared to the non-obese OSA group (22 ± 12 events, p < 0.05). In multivariate analysis, BMI significantly predicted number of acidic reflux events (r 2 = 0.16, p = 0.01) during the 24-h period; however, AHI showed no significant association with any measure of GER severity. Conclusions: This study confirms an important role for obesity, rather than OSA per se in the relationship between OSA and GER.

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Section: Discussionmentioning

confidence: 99%

Mechanism of Gastroesophageal Reflux in Obstructive Sleep Apnea: Airway Obstruction or Obesity?

Shepherd

Orr

2016

Journal of Clinical Sleep Medicine

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“…There is general agreement that esophageal manometry should be performed in all patients considered for Taking all these into account, the following patients are good candidates for antireflux surgery: (1) defective antireflux surgery. Esophageal manometry provides important information on esophageal body motility and the LES, especially if esophageal peristalsis is poor; (2) young patients (=60 years) who require long-term medical treatfunction of the LES [70]. Manometry helps to define the resting pressure of the LES, its ability to relax, the intra-ment in order to be free of symptoms [78]; (3) atypical symptoms such as massive regurgitation, dysphagia, resabdominal and overall length of the sphincter and its exact location.…”

Section: Patients Suitable For Antireflux Surgery How Are Patients Sementioning

confidence: 99%

Selection of Patients for Laparoscopic Antireflux Surgery

Glaser¹,

Wetscher²,

Klingler³

et al. 2000

Dig Dis

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Since the first laparoscopic fundoplication was performed, the frequency of antireflux surgery has increased rapidly with some centers now having an experience of about 1,000 procedures. The question arises whether this increase is due to a change in indications for the surgical treatment of gastrointestinal reflux disease (GERD) despite the simultaneous appearance of powerful antisecretory medications. Adequate knowledge of the pathophysiology of GERD is necessary in order to establish selection criteria for patients suitable for laparoscopic antireflux surgery. In this article, we review the epidemiology and pathophysiology, and provide a rationale for medical and surgical treatment. We also offer an approach to patient selection for antireflux surgery.

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“…The intrinsic tone of the LES muscle and the resultant high pressure zone provide an important barrier for the pre vention of reflux from the intra-abdominal stomach into the lower pressure intrathoracic esophagus. In some animal models, the in creased pressure of the LES appears to be pri marily myogenic; however, in humans, part of the increased LES pressure is due to neurally mediated cholinergic input [9], Besides the LES pressure, the surgical liter ature also suggests that the length of the intra abdominal portion of the LES is an additional important barrier to reflux [10,11]. Normally the LES straddles the gastroesophageal junc tion so that of its about 3.5 cm length, about 2 cm of the LES high pressure zone is at or below the respiratory inversion point, a mark er of the transition from intra-abdominal lo cation to intrathoracic location.…”

Section: Lower Esophageal Sphinctermentioning

confidence: 99%

Contributing Role of Motility Abnormalities in the Pathogenesis of Gastroesophageal Reflux Disease

Parkman

Fisher²

1997

Dig Dis

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Although many factors are involved in the pathogenesis of gastroesophageal reflux disease (GERD), the antirefiux barrier at the gastroesophageal junction is the final determinate of reflux. In the majority of cases, transient lower esophageal sphincter (LES) relaxations appear to be the necessary condition for reflux to occur. In severe cases of GERD, especially those with esophagitis, stricture, and Barrett’s epithelium, diminished resting LES pressure plays a contributory role. Esophageal dysmotility may be an additive factor leading to increased esophageal acid contact time and predispose patients to developing erosive esophagitis. Also, delayed gastric emptying may further compromise the LES. Finally, the role of bile reflux across an incompetent gastroduodenal (pyloric) junction remains controversial.

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Interaction of lower esophageal sphincter pressure and length of sphincter in the abdomen as determinants of gastroesophageal competence

Cited by 125 publications

References 16 publications

Mechanism of Gastroesophageal Reflux in Obstructive Sleep Apnea: Airway Obstruction or Obesity?

Mechanism of Gastroesophageal Reflux in Obstructive Sleep Apnea: Airway Obstruction or Obesity?

Selection of Patients for Laparoscopic Antireflux Surgery

Contributing Role of Motility Abnormalities in the Pathogenesis of Gastroesophageal Reflux Disease

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