On the pathogenesis of gastroesophageal reflux: The concept of gastroesophageal dyssynergia

Abstract

The current study has demonstrated that the lower esophageal sphincter and crural diaphragm in patients with gastroesophageal reflux disease exhibited a diminished resting electric activity and either did not respond or reacted paradoxically to esophageal and gastric distention, constituting what we call esophagosphincteric and gastroesophageal paradox or dyssynergia. The cause of lower esophageal sphincter and crural diaphragm dysfunction is not known; a neurogenic cause was proposed. Further studies are required to investigate this point.

Dysphagia-Gastroesophageal Reflux Complex: Complications Due to Dysfunction of Solitary Tract Nucleus-Mediated Vago-Vagal Reflex

“…Mediated by the vagal afferents, the reflex relaxation of LES results from pharyngeal and esophageal distension [1,25], and the reflex contraction of LES results from gastric distension and increased abdominal pressure [20,21,31]. The latter reflex is abnormal in adult patients with GERD and the term "gastroesophageal dyssynergia" is proposed to describe such a pathomechanism of GER [30]. Although other neurological findings were not described for this series of adult patients, there are similarities with the GERD of the patients in the present report to suggest a causal relationship with the observed brainstem lesions, as discussed below.…”

Reaction to Articles on High Resolution Manometry, the Length of the Lower Esophageal Sphincter and the Diagnosis of Gastroesophageal Reflux Disease

“…Secondly, measurements of basal pressure and length of the lower esophageal sphincter have low accuracy, which is evidenced by Abdominal compression causes an increase an intra-abdominal and intragastric pressure. This leads to a reflex increase of the LES pressure (7) . In healthy individuals, the last peristaltic wave overcomes the tone of the LES and the contrast agent penetrates from the esophagus into the stomach without delay.…”