Sphincterlike thoracoabdominal high pressure zone after esophagogastrectomy

Klein, W; Parkman, Henry P.; Dempsey, Daniel T.; Fisher, Robert S.

doi:10.1016/0016-5085(93)90140-8

Cited by 84 publications

(41 citation statements)

References 30 publications

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“…After surgical resection of the LES as a part of cancer therapy, patients revealed pressure components of the LES, creating a long sphincter complex with two HPZs. Each of these zones seem to an end-expiratory intraluminal pressure of 6 mm Hg within the sphincterless gastroesophageal junction [12]. play an independent role in preventing reflux.…”

Section: Discussionmentioning

confidence: 99%

Manometric Components of the Lower Esophageal Double Hump

Alexander¹,

Raiser²,

Swain³

et al. 2000

Dig Dis

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Background/Aims: The lower esophageal sphincter manometry of patients with hiatal hernia often displays a double hump configuration. It seems that this is due to gastric herniation above the high-pressure zone of the crura. This study examines this manometric phenomenon in patients with hiatal hernia and relates it to the lower esophageal antireflux barrier. Methods: Manometric and 24-hour pH studies of 68 consecutive patients with suspected gastroesophageal reflux disease were analyzed to obtain information regarding the double hump and acid reflux. Results: The findings of a manometric double hump correlated well with the presence of a hiatal hernia of >5 cm. The overall length of the sphincter complex was greater in patients with a double hump, but the length below the respiratory inversion point was constant. Resting pressures at the respiratory inversion point were significantly lower than those measured at either high-pressure zone. The location of the respiratory inversion point was seen most commonly at the superior margin of the distal high-pressure zone. Double hump patients with a negative acid reflux score were found to have higher pressures in the distal high-pressure zone than those patients with acid reflux. Conclusions: The two high-pressure zones comprising the manometric double hump represent the crural and muscular components of the lower esophageal sphincter. Descriptive information regarding the double hump phenomenon is given, and the importance of the crural component of the lower esophageal sphincter in preventing acid reflux is stressed.

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Section: Discussionmentioning

confidence: 99%

Manometric Components of the Lower Esophageal Double Hump

Alexander¹,

Raiser²,

Swain³

et al. 2000

Dig Dis

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“…Gaining acceptance as a cofactor in the pathogenesis of GERD is anatomical distortion of the EGJ inclusive of, but not limited to, hiatus hernia (7,9,13,14). When examining GERD in the context of hiatus hernia, certain distinctions become evident.…”

mentioning

confidence: 99%

“…This functional compromise can be attributable to perturbation of a number of anatomical or physiological components of the EGJ, including the intrinsic lower esophageal sphincter (LES), the extrinsic compression of the distal esophagus at the diaphragmatic hiatus, the intra-abdominal location of the LES, or the physiology of transient LES relaxations (tLESRs). Physiological investigations suggest that the net result of these perturbations is an increased number of acid reflux events by three mechanisms: 1) tLESR, 2) strain-induced reflux in the setting of a hypotensive LES, or 3) free reflux during periods of low LES pressure or deglutitive relaxation (1,12,19).Gaining acceptance as a cofactor in the pathogenesis of GERD is anatomical distortion of the EGJ inclusive of, but not limited to, hiatus hernia (7,9,13,14). When examining GERD in the context of hiatus hernia, certain distinctions become evident.…”

mentioning

confidence: 99%

Esophagogastric junction distensibility: a factor contributing to sphincter incompetence

Pandolfino

Shi

Curry

et al. 2002

American Journal of Physiology-Gastrointestinal and Liver Physi

132

118

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Kahrilas. Esophagogastric junction distensibility: a factor contributing to sphincter incompetence. Am J Physiol Gastrointest Liver Physiol 282: G1052-G1058, 2002 10.1152/ ajpgi.00279.2001.-To quantify the effect of hiatus hernia (HH) on esophagogastric junction (EGJ) distensibility, eight normal subjects and nine gastroesophageal reflux disease (GERD) patients with HH were studied with concurrent manometry, fluoroscopy, and stepwise controlled barostatic distention of the EGJ. The minimal barostatic pressure required to open the EGJ during the interswallow period was determined. Thereafter, barium swallows were imaged in 5-mmHg increments of intrabag pressure. EGJ diameter and length were measured at each pressure during deglutitive relaxation. The EGJ opening diameter was greater in hernia patients compared with normal subjects during deglutitive relaxation at all pressures, and EGJ length was 23% shorter. EGJ opening pressure among hernia patients was lower than normal subjects during the interswallow period. In conclusion, the EGJ of GERD patients with HH was more distensible and shorter than normal subjects. These findings partially explain why HH patients are predisposed to reflux by mechanisms other than transient lower esophageal sphincter relaxations, sustain greater volumes of refluxate, and have a reduced ability to discriminate gas from liquid reflux. hiatus hernia; gastroesophageal reflux disease THE CARDINAL ABNORMALITY of gastroesophageal reflux disease (GERD) is incompetence of the esophagogastric junction (EGJ) to reflux of gastric secretions. This functional compromise can be attributable to perturbation of a number of anatomical or physiological components of the EGJ, including the intrinsic lower esophageal sphincter (LES), the extrinsic compression of the distal esophagus at the diaphragmatic hiatus, the intra-abdominal location of the LES, or the physiology of transient LES relaxations (tLESRs). Physiological investigations suggest that the net result of these perturbations is an increased number of acid reflux events by three mechanisms: 1) tLESR, 2) strain-induced reflux in the setting of a hypotensive LES, or 3) free reflux during periods of low LES pressure or deglutitive relaxation (1,12,19).Gaining acceptance as a cofactor in the pathogenesis of GERD is anatomical distortion of the EGJ inclusive of, but not limited to, hiatus hernia (7,9,13,14). When examining GERD in the context of hiatus hernia, certain distinctions become evident. Patients with more severe forms of GERD, such as erosive esophagitis and Barrett's metaplasia, almost invariably have a hiatus hernia (2, 18), and GERD patients with hiatus hernia have increased esophageal acid exposure compared with patients without hiatus hernia (8, 18). The mechanistic profile for reflux in hiatus hernia patients is also distinct. Whereas tLESRs can account for up to 90% of reflux events in normal subjects or in patients without hiatus hernia, patients with hiatus hernia have a more heterogeneous mechanistic profile with reflux episod...

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“…This antireflux barrier is comprised of several fac tors including the tonic pressure of the LES, the phasic action of the crural diaphragm, the intra-abdominal segment of distal esophagus, the acuity of the angle formed at the junction of the esophagus and stomach (angle of His), and the ligamentous attachments at the gas troesophageal junction (primarily the phrenoesophageal ligament) [6][7][8],…”

Section: Introductionmentioning

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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Sphincterlike thoracoabdominal high pressure zone after esophagogastrectomy

Cited by 84 publications

References 30 publications

Manometric Components of the Lower Esophageal Double Hump

Manometric Components of the Lower Esophageal Double Hump

Esophagogastric junction distensibility: a factor contributing to sphincter incompetence

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

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