Esophagogastric junction distensibility: a factor  contributing to sphincter incompetence

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.

Download Full-text

Tu1283 – Esophagogastric Junction Outflow Obstruction Associated with Hypercontractility May Represent Primary Lower Esophageal Sphincter Dysfunction in Patients with Suspected Gastroesophageal Reflux Disease

Gastroenterology ◽

10.1016/s0016-5085(19)39493-4 ◽

2019 ◽

Vol 156 (6) ◽

pp. S-1017-S-1018

Author(s):

Chuma Obineme ◽

Salih Samo ◽

Nikrad Shahnavaz ◽

Jennifer A. Christie ◽

Anand Jain

Keyword(s):

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Lower Esophageal Sphincter ◽

Reflux Disease ◽

Esophagogastric Junction ◽

Outflow Obstruction ◽

Esophageal Sphincter

Download Full-text

Food and Gastroesophageal Reflux Disease

Current Medicinal Chemistry ◽

10.2174/0929867324666170515123807 ◽

2019 ◽

Vol 26 (19) ◽

pp. 3497-3511 ◽

Cited By ~ 16

Author(s):

Teodora Surdea-Blaga ◽

Dana E. Negrutiu ◽

Mariana Palage ◽

Dan L. Dumitrascu

Keyword(s):

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Lower Esophageal Sphincter ◽

Reflux Disease ◽

Current Knowledge ◽

Positive Association ◽

Sphincter Pressure ◽

Low Carbohydrate Diet ◽

Reflux Symptoms ◽

Esophageal Sphincter

Gastroesophageal reflux disease is a chronic condition with a high prevalence in western countries. Transient lower esophageal sphincter relaxation episodes and a decreased lower esophageal sphincter pressure are the main mechanisms involved. Currently used drugs are efficient on reflux symptoms, but only as long as they are administered, because they do not modify the reflux barrier. Certain nutrients or foods are generally considered to increase the frequency of gastroesophageal reflux symptoms, therefore physicians recommend changes in diet and some patients avoid bothering foods. This review summarizes current knowledge regarding food and gastroesophageal reflux. For example, fat intake increases the perception of reflux symptoms. Regular coffee and chocolate induce gastroesophageal reflux and increase the lower esophageal exposure to acid. Spicy foods might induce heartburn, but the exact mechanism is not known. Beer and wine induce gastroesophageal reflux, mainly in the first hour after intake. For other foods, like fried food or carbonated beverages data on gastroesophageal reflux is scarce. Similarly, there are few data about the type of diet and gastroesophageal reflux. Mediterranean diet and a very low carbohydrate diet protect against reflux. Regarding diet-related practices, consistent data showed that a “short-meal-to-sleep interval” favors reflux episodes, therefore some authors recommend that dinner should be at least four hours before bedtime. All these recommendations should consider patient’s weight, because several meta-analyses showed a positive association between increased body mass index and gastroesophageal reflux disease.

Download Full-text