Kinetics of transient hiatus hernia during transient lower esophageal sphincter relaxations and swallows in healthy subjects

Abstract

The marked proximal GEJ migration during TLESRs represents very severe herniation of the GEJ. The rapid initial return of the GEJ following TLESRs when the crural diaphragm is relaxed and its correlation with amplitude suggest it is due to elastic recoil of the phreno-esophageal ligament. The marked stretching of the phreno-esophageal ligament during TLESRs may contribute to its weakening and development of established hiatus hernia.

The Acid Pocket: A Target for Treatment in Reflux Disease?

“…Assuming that the acid pocket migrates upwards with the LES, a situation comparable to a hernia would result promoting acid refl ux. In fact, continuous postprandial monitoring of the location of the EGJ in healthy volunteers confi rmed that during TLESRs there was marked proximal movement of the EGJ by a median of 4.3 cm, representing signifi cant herniation ( 46 ). Th e Bredenoord and Beaumont studies also reported that spatial separation between the LES and crural diaphragm increases the risk ( 19 ).…”

Kinematic analysis of swallowing in the patients with esophagectomy for esophageal cancer

“…Swallowing motion can be analyzed and quantified by kinematic data using motion analysis (Paik et al, 2008), kinetic data using manometry (Lee et al, 2012), and muscle activities using dynamic electromyography (Yu et al, 2013) can be easily performed by videofluoroscopic swallowing studies (VFSS) without any discomfort, contrary to kinetic and electromyographic analyses, which cause substantial discomfort. Moreover, the extent and pattern of the hyoid bone and the epiglottis movement revealed by kinematic analysis can differentiate etiologies of dysphagia and suggest the mechanism of dysphagia (Paik et al, 2008).…”

Relevance of Position and Movement of the Gastroesophageal Junction in Gastroesophageal Reflux Disease

“…More recent evidence, using a novel Hall-effect technique that allows continuous measurement of the location of the GEJ without the need for fluoroscopy, indicates that TLESRs are a severe but transient form of hiatus herniation 4,5. Furthermore, partial hiatus hernia is likely to be common especially in the presence of obesity and raised intra-abdominal pressure 6.…”