scholarly journals Radiologic and Endoscopic Characteristics of Laparoscopic Antireflux Wrap: Correlation With Outcome

2012 ◽  
Vol 97 (3) ◽  
pp. 189-197 ◽  
Author(s):  
Italo Braghetto ◽  
Owen Korn ◽  
Attila Csendes ◽  
Héctor Valladares ◽  
Cristóbal Davanzo ◽  
...  
Keyword(s):  
Lower Esophageal Sphincter ◽  
Ph Monitoring ◽  
Erosive Esophagitis ◽  
Acid Reflux ◽  
Failed Fundoplication ◽  
Esophageal Sphincter ◽  
Endoscopic Characteristics ◽  
Definition Of ◽  
Antireflux Barrier

Abstract After antireflux surgery for gastroesophageal reflux disease, 10% to 15% of patients may have unsuccessful results as a result of abnormal restoration of the esophagogastric junction. The purpose of this study was to evaluate the postoperative endoscopic and radiologic characteristics of the antireflux barrier and their correlation with the postoperative results. After surgery, endoscopic and radiologic features of the antireflux wrap were evaluated in 120 consecutive patients. Jobe's classification of the postoperative valve was used for the definition of a “normal” or “defective” wrap. Patients were evaluated 3 to 5 years later in order to determine the clinical and objective failed fundoplication. A “normal” antireflux wrap was associated with successful results in 81.7% of the patients. On the contrary, defective radiologic or endoscopic antireflux wrap was observed in 19% of cases. Among these patients, hypotensive lower esophageal sphincter was observed in 50% to 65% of patients, abnormal 24-hour pH monitoring in 91%, and recurrent postoperative erosive esophagitis in 50% of patients, respectively (P < 0.001). “Defective” antireflux fundoplication is associated with recurrent reflux symptoms, presence of endoscopic esophagitis, hypotensive lower esophageal sphincter, and abnormal acid reflux.

Criteria for objective definition of transient lower esophageal sphincter relaxation

1995 ◽  
Vol 268 (1) ◽  
pp. G128-G133 ◽  
Author(s):  
R. H. Holloway ◽  
R. Penagini ◽  
A. C. Ireland
Keyword(s):  
Relaxation Rate ◽  
Lower Esophageal Sphincter ◽  
Visual Recognition ◽  
Ph Monitoring ◽  
Normal Subjects ◽  
Systematic Analysis ◽  
Complete Relaxation ◽  
Esophageal Sphincter ◽  
Definition Of ◽  
Pressure Fall

We developed and evaluated objective manometric criteria that define transient lower esophageal sphincter (LES) relaxation. In 23 normal subjects and 9 patients with gastroesophageal reflux disease, systematic analysis of swallow-induced LES relaxation showed that dry swallows preceded LES relaxation by a median of 1.4 s. The relaxation rate was always > 1 mmHg/s, the relaxation nadir always occurred within 7 s, and the duration of relaxation was < 9 s. During concurrent esophageal manometry and pH monitoring, 104 reflux episodes associated with a LES pressure fall that was not related to swallowing were identified and the pressure falls classified as transient LES relaxations or not by visual recognition. LES pressure was always < or = 2 mmHg at time of reflux, and relaxation was significantly longer than for swallow-induced LES relaxation. Of 88 pressure falls classified visually as transient LES relaxations, 90% reached nadir pressure within 7 s at a rate of > 1 mmHg/s. Sixteen pressure falls were classified as a gradual downward drift in LES pressure, which in 15 cases was < 1 mmHg/s. Based on the analysis, transient LES relaxation can be defined by 1) absence of swallowing for 4 s before to 2 s after the onset of LES relaxation, 2) relaxation rate of > or = 1 mmHg/s, 3) time from onset to complete relaxation of < or = 10 s, and 4) nadir pressure of < or = 2 mmHg.(ABSTRACT TRUNCATED AT 250 WORDS)

Healing of erosive esophagitis with sucralfate and cimetidine: Influence of pretreatment lower esophageal sphincter pressure and serum pepsinogen I levels

1991 ◽  
Vol 91 (2) ◽  
pp. S107-S113 ◽  
Author(s):  
Emilio Ros ◽  
Victor Toledo-Pimentel ◽  
Josep M. Bordas ◽  
Luis Grande ◽  
Gloria Lacima ◽  
...  
Keyword(s):  
Lower Esophageal Sphincter ◽  
Erosive Esophagitis ◽  
Lower Esophageal Sphincter Pressure ◽  
Sphincter Pressure ◽  
Serum Pepsinogen ◽  
Pepsinogen I ◽  
Esophageal Sphincter

scholarly journals Surgical treatment of the non-complicated gastroesophageal reflux: fundoplication without division of the short gastric vessels

2002 ◽  
Vol 39 (2) ◽  
pp. 93-97 ◽  
Author(s):  
Valter Nilton FELIX ◽  
Ioshiaki YOGI ◽  
Marcos PERINI ◽  
Rodrigo ECHEVERRIA ◽  
Cristiano BERNARDI
Keyword(s):  
Surgical Treatment ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Lower Esophageal Sphincter ◽  
Reflux Disease ◽  
Nissen Fundoplication ◽  
Erosive Esophagitis ◽  
Sphincter Pressure ◽  
Esophageal Sphincter ◽  
Short Gastric Vessels

Background - There is today a significant greater number of laparoscopic antireflux procedures for the surgical treatment of gastroesophageal reflux disease and there are yet controversies about the necessity of division of the short gastric vessels and full mobilization of the gastric fundus to perform an adequate fundoplication. Aim - To verify the results of the surgical treatment of non-complicated gastroesophageal reflux disease performing Rossetti modification of the Nissen fundoplication. Patients and Methods - Fourteen patients were operated consecutively and prospectively (mean age 44.07 years); all had erosive esophagitis without Barrett's endoscopic signals (grade 3, Savary-Miller) and they were submitted to the Rossetti modification of the Nissen fundoplication. Endoscopy, esophageal manometry and pHmetry were performed before the procedure and around 18 months postoperatively. Results - There was no morbidity, transient dysphagia average was 18.42 days; there was no register of dehiscence or displacement of the fundoplication and only one patient revealed a light esophagitis at postoperative endoscopy; the others presented a normal endoscopic view of the distal esophagus. All noticed a marked improvement of preoperative symptoms. Lower esophageal sphincter pressure changed from 5.82 mm Hg (preoperative mean) to 12 mm Hg (postoperative mean); lower esophageal sphincter relaxing pressure, from 0.38 mm Hg to 5.24 mm Hg and DeMeester score, from 16.75 to 0.8. Conclusion - Rossetti procedure (fundoplication without division of the short gastric vessels) is an effective surgical method to treat gastroesophageal reflux disease.

Lower esophageal sphincter pressure as an index of gastroesophageal acid reflux

1981 ◽  
Vol 26 (11) ◽  
pp. 993-998 ◽  
Author(s):  
George Ahtaridis ◽  
William J. Snape ◽  
Sidney Cohen
Keyword(s):  
Lower Esophageal Sphincter ◽  
Acid Reflux ◽  
Lower Esophageal Sphincter Pressure ◽  
Sphincter Pressure ◽  
Esophageal Sphincter

scholarly journals Day-to-day discrepancy in Bravo pH monitoring is related to the degree of deterioration of the lower esophageal sphincter and severity of reflux disease

2011 ◽  
Vol 25 (7) ◽  
pp. 2219-2223 ◽  
Author(s):  
Shahin Ayazi ◽  
Jeffrey A. Hagen ◽  
Joerg Zehetner ◽  
Farzaneh Banki ◽  
Florian Augustin ◽  
...  
Keyword(s):  
Lower Esophageal Sphincter ◽  
Reflux Disease ◽  
Ph Monitoring ◽  
Esophageal Sphincter

T1231 Transient Lower Esophageal Sphincter Relaxations (TLESRs) May Be An Even More Important Mechanism Underling Acid Reflux Episodes

2009 ◽  
Vol 136 (5) ◽  
pp. A-527
Author(s):  
Katsuhiko Iwakiri ◽  
Noriyuki Kawami ◽  
Hirohito Sano ◽  
Yuriko Tanaka ◽  
Mariko Umezawa ◽  
...  
Keyword(s):  
Lower Esophageal Sphincter ◽  
Acid Reflux ◽  
Esophageal Sphincter

Validation of criteria for the definition of transient lower esophageal sphincter relaxations using high-resolution manometry

2016 ◽  
Vol 29 (2) ◽  
pp. e12920 ◽  
Author(s):  
S. Roman ◽  
R. Holloway ◽  
J. Keller ◽  
F. Herbella ◽  
F. Zerbib ◽  
...  
Keyword(s):  
High Resolution ◽  
Lower Esophageal Sphincter ◽  
High Resolution Manometry ◽  
Esophageal Sphincter ◽  
Definition Of

861 Effect of the GABAB Receptor Agonist Azd9343 On Transient Lower Esophageal Sphincter Relaxations and Acid Reflux in Healthy Volunteers: A Phase I Trial

2008 ◽  
Vol 134 (4) ◽  
pp. A-126 ◽  
Author(s):  
Guy E. Boeckxstaens ◽  
Hanneke Beaumont ◽  
Hans Rydholm ◽  
Magnus Ruth ◽  
Aaltje Lei ◽  
...  
Keyword(s):  
Phase I ◽  
Healthy Volunteers ◽  
Lower Esophageal Sphincter ◽  
Receptor Agonist ◽  
Phase I Trial ◽  
Gabab Receptor ◽  
Acid Reflux ◽  
Esophageal Sphincter

Characteristics of transient lower esophageal sphincter relaxation in humans

1987 ◽  
Vol 252 (5) ◽  
pp. G636-G641 ◽  
Author(s):  
R. K. Mittal ◽  
R. W. McCallum
Keyword(s):  
Electrical Activity ◽  
Lower Esophageal Sphincter ◽  
Healthy Subjects ◽  
Acid Reflux ◽  
Equal Frequency ◽  
Mylohyoid Muscle ◽  
Postprandial State ◽  
Lower Esophageal Sphincter Relaxation ◽  
Esophageal Sphincter ◽  
Esophageal Contraction

Transient lower esophageal sphincter relaxations (TLESR) were studied in 10 normal healthy subjects. Electrical activity of mylohyoid muscle measured by an electromyogram (MEMG), pressures from pharynx, three esophageal sites, lower esophageal sphincter, and stomach were simultaneously recorded for 1 h, while fasting and 3 h after an 850 kcal meal. Reflux of acid into esophagus and/or occurrence of belching accompanying a TLESR was also monitored. TLESRs occurred with an equal frequency in fasting and postprandial state (6.2 vs. 6.4 h). However, frequency of an acid reflux during a TLESR was much greater postprandially than after fasting (44.8 vs. 9.6%). Belching coincided with 8% of TLESRs. A small MEMG complex and a small pharyngeal complex were present at onset of TLESR in 41.6 and 26.9% of instances, respectively. TLESRs were then categorized as either postswallow, if it occurred within 10 s of a preceding swallow-induced LES relaxation, or isolated, if its onset to previous swallow was greater than 10 s. Esophageal contractions were noticed at onset of 84% of isolated TLESRs. When present at two distal sites, this contraction was always of a simultaneous nature. Esophageal contractions at onset of postswallow TLESR were less frequent (33.3%) but when present were usually observed at the proximal esophageal site. At completion of a TLESR, the LES never recovered without an associated esophageal contraction, the latter was either swallow mediated or a spontaneous simultaneous esophageal contraction. Our data indicate that 1) MEMG and pharyngeal motor events may accompany TLESRs; and 2) esophageal contraction frequently heralds the onset, and it always occurs at completion of a TLESR.(ABSTRACT TRUNCATED AT 250 WORDS)

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