The Lower Esophageal Intrinsic Sphincter and the Mechanism of Reflux

Anderson, Howard N.; May, Karl J.; Steinmetz, George P.; Ofstun, Milford S.; Harrison, Harmon G.; Leyse, Robert M.; Dillard, David H.

doi:10.1097/00000658-196707000-00013

Cited by 15 publications

(4 citation statements)

References 7 publications

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“…However, as we have reported in a paper titled "Conservative Operations for Peptic Esophagitis" (Ann Thorac Surg 13: 6,1972), when dealing with a short esophagus the fundoplication should not be "forced" below the diaphragm and can be left in the chest. We have demonstrated excellent re¬ sults with complete healing of the peptic esophageal lesions a few days after the op¬ eration.…”

Section: Commentmentioning

confidence: 94%

Nissen Fundoplication Without Crural Repair

Safaie-Shirazi¹

1974

Arch Surg

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Section: Commentmentioning

confidence: 94%

Nissen Fundoplication Without Crural Repair

Safaie-Shirazi¹

1974

Arch Surg

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“…Functionally, the LES is located at the level of the diaphragm as a 1 cm long area with increased pressure inside the esophageal lumen between oesophagus and stomach. The LES works in conjunction with the diaphragm to create a physical barrier against the entry of gastric contents into the esophagus and maintains the unidirectional flow of ingesta (3,54). The transient relaxation of the LES is mediated vagally and by local reflexes, and is associated with swallowing and triggered by gastric distension (14).…”

Section: Introductionmentioning

confidence: 99%

“…The presence of GER does not necessarily cause clinical signs, because several factors protect the esophageal mucosa from injury. In dogs, normal LES function is thought to be the main mechanism for preventing reflux (3). Other protective mechanisms include the physiologic esophageal peristalsis clearing the esophagus from refluxed material, the buffering of gastric acid by bicarbonate secreted into the saliva, and the natural resistance of the esophageal mucosa to injury due to its stratified squamous epithelium, its submucosal glands, and its vascularity (30,48,50,52).…”

Section: Introductionmentioning

confidence: 99%

Idiopathic esophagopathies resembling gastroesophageal reflux disease in dogs

Münster¹,

Hörauf²,

Lübke‐Becker³

et al. 2013

Tierarztl Prax Ausg K

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Objective: Pathologic gastroesophageal reflux (GER) has been demonstrated experimentally in dogs, and it is suspected to occur naturally in dogs, yet its clinical significance is unknown. The aim of the study was to demonstrate clinical indicators of pathologic GER in dogs with idiopathic esophagopathies. Materials and methods: Dogs with clinical signs suggestive for esophageal disease (regurgitation, ptyalism, or dysphagia) and where extraesophageal and specific esophageal diseases had been ruled out, were retrospectively diagnosed with idiopathic esophagopathies. History, physical examination findings, clinicopathologic, radiographic, and endoscopic data, and treatment results were obtained from medical records, reviewed and evaluated. Results: Out of 67 dogs with anamnestic esophageal signs, 12 (17.4%) dogs were identified as having idiopathic esophagopathies and were included in the study. Median age was 3.0 years (range 1.0-11.0), and median bodyweight was 28.2 kg (range 8.2-44.0). The most frequent anamnestic esophageal signs were ptyalism (10/12 dogs), regurgitation (8/12 dogs), signs of discomfort, pain (8/12 dogs), and cough (5/12 dogs). The most common radiographic abnormality was segmental esophageal dilation (8/12 dogs). Esophagoscopy revealed single mucosal surface defects at the gastroesophageal junction in 3/12 dogs. In dogs with altered esophageal motility, cytological and microbiological examinations of bronchial aspirates showed goblet cell hyperplasia (8/8 dogs), neutrophilic infiltration (5/8 dogs) and culturable bacteria (4/8 dogs), respectively. All dogs were treated with omeprazole (median 0.7 mg/kg once per day, range 0.5-1.2). Reported median treatment duration until remission of the main clinical signs was 20.0 days (range 8.0-54.0 days). This endpoint was reached in 11/12 dogs. Conclusion and clinical relevance: Results suggest that in some dogs with esophageal clinical signs, and where no primary disease could be identified, clinical indicators of pathologic GER such as pain, mucosal lesions and motility disturbances of the esophagus, respiratory complications, and response to therapy can be observed.

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“…Abnormal gastric emptying results in the stomachÕs distension and enhanced spontaneous relaxation of the lower esophageal sphincter (LES), which are considered the major factors of the GERD [7,8]. Furthermore, both receptive and accommodative function disorders result in increased intragastric pressure above the physiologic values, thereby enhancing the reflux [9].…”

mentioning

confidence: 99%