The Esophagogastric Junction

Mittal, Ravinder K.; Balaban, David H.

doi:10.1056/nejm199703273361306

Cited by 551 publications

(331 citation statements)

References 40 publications

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“…11 Postmenopausal use of estrogens is associated with increased plasma NO levels 20 , and NO is a principal neurotransmitter for relaxation of the lower esophageal sphincter. 21 NO is also associated with transient relaxations of the lower esophageal sphincter 22 , one of the primary mechanisms underlying gastroesophageal reflux in healthy volunteers 23 and patients with reflux esophagitis. 24 Previously, it has been shown that postmenopausal women taking unopposed estrogen had higher plasma NO levels than women taking the same dose of estrogen coupled with the progestin levonorgestrel.…”

Section: Commentmentioning

confidence: 99%

Postmenopausal Hormone Use and Symptoms of Gastroesophageal Reflux

Jacobson

Moy

Colditz

et al. 2009

Obstetrical &Amp; Gynecological Survey

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Context-Previous studies suggest that elevated levels of estrogen and progesterone, either through endogenous or exogenous sources, increase gastroesophageal reflux.Objective-To evaluate the relationship between symptoms of gastroesophageal reflux disease and postmenopausal hormone therapy, including the use of selective estrogen receptor modulators and over-the-counter hormone preparations.Design, setting, and participants-Prospective cohort study of 51,637 postmenopausal women enrolled in the Nurses' Health Study who provided data on the use of hormone therapy biennially since 1976, and information about symptoms of gastroesophageal reflux in 2002.Main outcome measure-Self-reported symptoms of heartburn or acid-regurgitation occurring at least once a week in the previous year (reflux symptoms).Results-Among eligible participants, 12,018 (23%) women reported reflux symptoms. Compared to women who never used postmenopausal hormones, the multivariate odds ratio (OR) for the risk of reflux symptoms was 1.46 (95% CI 1.36-1.56) for past hormone users, 1.66 (95% CI 1.54-1.79) for current users of estrogen only, and 1.41 (95% CI 1.29-1.54) for current users of combined estrogen and progesterone. The risk of reflux symptoms increased significantly with increasing estrogen dose (P < 0.001) and increasing duration of estrogen use (P < 0.001). Moreover, current selective estrogen receptor modulator users experienced an OR of 1.39 (95% CI 1.22-1.59) for reflux symptoms, and women currently using over-the-counter hormone preparations had an OR of 1.37 (95% CI 1.16-1.62). Conclusions-Postmenopausal use of estrogens, selective estrogen receptor modulators, or overthe-counter hormone preparations is associated with an increased risk of symptoms of gastroesophageal reflux. This suggests a hormonal component to the pathophysiology of gastroesophageal reflux in women.

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Section: Commentmentioning

confidence: 99%

Postmenopausal Hormone Use and Symptoms of Gastroesophageal Reflux

Jacobson

Moy

Colditz

et al. 2009

Obstetrical &Amp; Gynecological Survey

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“…The beauty of the complexity lies in the fact that it provides a myriad of possibilities for novel surgical, endoscopic, and pharmacologic approaches to treat sphincter dysfunction [31]. FLIP measurement provides a comprehensive evaluation of sphincter resistance to mechanical distension.…”

Section: Discussionmentioning

confidence: 99%

“…The anatomy and physiology of the EGJ have been studied extensively using endoscopy, barium esophagram, manometry, and magnetic resonance imaging [28][29][30][31]. In recent years, several studies have also used the FLIP to characterize the functional properties of the esophagus and the EGJ.…”

Section: Gastroesophageal Reflux Diseasementioning

confidence: 99%

Functional lumen imaging of the gastrointestinal tract

et al. 2015

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This nonsystematic review aims to describe recent developments in the use of functional lumen imaging in the gastrointestinal tract stimulated by the introduction of the functional lumen imaging probe. When ingested food in liquid and solid form is transported along the gastrointestinal tract, sphincters provide an important role in the flow and control of these contents. Inadequate function of sphincters is the basis of many gastrointestinal diseases. Despite this, traditional methods of sphincter diagnosis and measurement such as fluoroscopy, manometry, and the barostat are limited in what they can tell us. It has long been thought that measurement of sphincter function through resistance to distension is a better approach, now more commonly known as distensibility testing. The functional lumen imaging probe is the first medical measurement device that purports in a practical way to provide geometric profiling and measurement of distensibility in sphincters. With use of impedance planimetry, an axial series of cross-sectional areas and pressure in a cathetermounted allantoid bag are used for the calculation of distensibility parameters. The technique has been trialed in many valvular areas of the gastrointestinal tract, including the upper esophageal sphincter, the esophagogastric junction, and the anorectal region. It has shown potential in the biomechanical assessment of sphincter function and characterization of swallowing disorders, gastroesophageal reflux disease, eosinophilic esophagitis, achalasia, and fecal incontinence. From this early work, the functional lumen imaging technique has the potential to contribute to a better and more physiological understanding of narrowing regions in the gastrointestinal tract in general and sphincters in particular.

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“…This allows analyses not possible previously by showing how gastric, diaphragmatic hiatal, hiatal sac, LOS and distal oesophageal body mechanics vary among patients (Pandolfino et al, 2003) and change from moment to moment (Bredenoord et al, 2006). Such studies are building on those of Mittal and colleagues with the sleeve and luminal electromyography which have clarified the significant role that contractions of the normally-positioned diaphragmatic hiatus play in bolstering the antireflux action of the LOS itself (Mittal and Balaban, 1997).…”

Section: Dissection Of the Mysteries Of Hiatus Herniamentioning

confidence: 99%

Approaches to driving the evolving understanding of lower oesophageal sphincter mechanical function

Dent

2007

J. Smooth Muscle Res.

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This article reviews and places into context the development of lower oesophageal sphincter (LOS) manometry, the key technique for researching the mechanics of this region. The first of two major challenges, being able to record sphincter pressure accurately with generally available equipment, was solved by the advent of perfused manometry in the 1960s. The other main challenge was to achieve reliable, continuous recording of LOS pressure, despite the constant movements of the LOS relative to the manometric catheter. Though well documented, this challenge is still poorly understood and prioritised, as many clinical/diagnostic and research manometric studies use methods for LOS manometry that are invalidated by LOS movement. There are two techniques that can record continuously from the LOS, despite its movements: high resolution manometry (HRM), which uses multiple point pressure sensors spaced at 1 cm interval or less, and the sleeve, which is a single long sensor. HRM provides valuable additional information on the varied topography of pressure patterns across the gastro-oesophageal junction and how this can change in an individual, second to second. HRM especially, but also sleeve manometry continue to advance understanding of the mechanics of gastro-oesophageal reflux, to unravel the mysteries of the mechanics of hiatus hernia and the diaphragmatic hiatus, to define why antireflux surgery fails or causes dysphagia, to recognise patients with dysphagia due to isolated defects of LOS relaxation and to test novel therapies for reflux disease directed at LOS function. Ample evidence now exists that accurate monitoring of LOS and gastro-oesophageal junction pressures is important for the diagnostic assessment of many patients and for advancing research into several aspects of the mechanical function of the LOS and its surrounding structures. This evidence now needs to be better reflected in the methods used for routine clinical practice and research.

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The Esophagogastric Junction

Cited by 551 publications

References 40 publications

Postmenopausal Hormone Use and Symptoms of Gastroesophageal Reflux

Postmenopausal Hormone Use and Symptoms of Gastroesophageal Reflux

Functional lumen imaging of the gastrointestinal tract

Approaches to driving the evolving understanding of lower oesophageal sphincter mechanical function

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