The closing mechanism at the gastroesophageal junction

Vantrappen, Gaston; Texter, E. Clinton; Barborka, Clifford J.; Vandenbroucke, Jan P.

doi:10.1016/0002-9343(60)90151-0

Cited by 55 publications

(13 citation statements)

References 39 publications

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“…Three mechanisms probably help to prevent gastroesophageal reflux: a direct compression or "pinch-cock" action on the esophagogastric junction exerted by the right crus of the diaphragm, an intrinsic sphincter mechanism in the distal esophagus, and a passive mucosal valve formed by the acute angle of entry of the esophagus into the stomach (21,22). These three barriers probably reinforce each other when properly aligned.…”

Section: Resultsmentioning

confidence: 99%

Heartburn in Late Pregnancy. Manometric Studies of Esophageal Motor Function*

Nagler¹,

Spiro²

1961

J. Clin. Invest.

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Section: Resultsmentioning

confidence: 99%

Heartburn in Late Pregnancy. Manometric Studies of Esophageal Motor Function*

Nagler¹,

Spiro²

1961

J. Clin. Invest.

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“…This has focused attention on the nature of the mechanism that normally prevents gastroesophageal reflux. Three mechanism are postulated (1, 2): one entails the existence of a "flap-valve" at the gastroesophageal junction (3); a second mechanism postulates a "pinchcock" action on the right crus of the diaphragm (4) ; and the third stresses the primary role of the intrinsic sphincter in the lower esophagus (5)(6)(7)(8). Although the anatomic demonstration of a sphincter in this location is not readily performed, manometric data have clearly demonstrated a zone that maintains an elevated resting pressure and relaxes as the peristaltic wave approaches (9).…”

Section: Discussionmentioning

confidence: 99%

Esophageal Motor Abnormalities Induced by Acid Perfusion in Patients With Heartburn*

Siegel¹,

Hendrix²

1963

J. Clin. Invest.

174

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The clinical diagnosis of esophagitis is suggested by the presence of severe heartburn which is aggravated by the recumbent position. The symptom is generally worse after eating and is relieved by antacids. It is generally held that increased reflux of gastric contents leads to the development of esophagitis and that the pain is associated with an inflammatory process. In many patients with symptoms that suggest a diagnosis of esophagitis, however, there is, no endoscopic or histologic evidence of inflammation. The poor correlation between the clinical diagnosis of esophagitis and the endoscopic and histologic observations led to an investigation of esophageal motor function in these patients. METHOD AND MATERIALSTwenty-five patients with the clinical diagnosis of esophagitis were studied. The clinical diagnosis was based on the following criteria: recurrent burning retrosternal pain, which was more severe after eating, aggravated by the recumbent position, and improved by antacids. Esophagoscopy was performed in all patients. Specific features noted were mucosal reddening, granularity, erosion, ulceration, stricture, and the presence and degree of gastroesophageal reflux. Esophageal biopsies were obtained from an involved area if gross changes were observed and from the distal 4 cm of esophagus when no endoscopic abnormalities were present. X rays of the upper gastrointestinal tract with special attention to the gastroesophageal junction were obtained in all patients. Radiographic evidence of hiatus hernia and esophageal reflux was sought with the patients in the Trendelenburg position. Acid perfusion of the lower esophagus, with the technique to be described, was performed on all patients.These patients were compared with a control group of 25 patients who had none of the criteria described above for the clinical diagnosis of esophagitis. The control group, some of whom had coronary artery disease, were *This investigation was supported by U. S. Public Health Service research grant A-1687(C4) and U. S. Public Health Service training grant 2A-5095(C4).t John and Mary R. Markle Scholar. not all esophagoscoped, but acid-perfusion studies and radiologic studies were performed in all. A tabulated description of the heartburn and the control groups is found in Tables I and II. Pathologic findings and motility records were graded without knowledge of the clinical or endoscopic findings. On the other hand, the esophagoscopist was usually under the impression that the clinical diagnosis was esophagitis.Esophageal motor studies were performed with the subj ect supine. Three open-tipped, water-filled polyvinyl catheters with the tips placed 5 cm apart were introduced into the stomach. The catheters were connected to external transducers that were leveled at the posterior axillary line, and simultaneous, four-channel, direct-writing recording was performed.' The catheters were withdrawn into the esophagus in 1-cm steps to measure the resting tone of the lower esophageal sphincter. After the resting pressure of the lower e...

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“…Frequently only the narrow abdominal portion of this sphincter imposes a pressure barrier between the gastric and esophageal lumina when the pleuroperitoneal pressure gradient is increased (2)(3)(4)(5)(6). Reflux in patients with sliding hiatal hernia has been attributed to the upward displacement of the sphincter and the absence of the abdominal segment (7,8).…”

mentioning

confidence: 99%

Response of the Physiologic Gastroesophageal Sphincter to Increased Intra-abdominal Pressure *

Vanderstappen¹,

Texter²

1964

J. Clin. Invest.

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A zone of increased intraluminal pressure interposed between the tubular esophagus and presumed to be due to tonically contracted circular muscle fibers was described by Fyke, Code, and Schlegel (1) in 1956. Frequently only the narrow abdominal portion of this sphincter imposes a pressure barrier between the gastric and esophageal lumina when the pleuroperitoneal pressure gradient is increased (2-6). Reflux in patients with sliding hiatal hernia has been attributed to the upward displacement of the sphincter and the absence of the abdominal segment (7,8).Although there is agreement concerning the importance of the compression effect of increased intra-abdominal pressure during inspiration in the maintenance of sphincter competency, the role of the diaphragmatic crura remains controversial. Monges (9) showed that a balloon filled with radiopaque liquid in the esophagogastric area is compressed during deep inspiration in a ring-like fashion that he attributed to right crural contraction. Our studies were designed to contrast the effects of passive abdominal compression and deep inspiration on intraluminal pressure and pH and thereby to differentiate a crural (pinchcock) action from a dome (intra-abdominal pressure) action of the diaphragm. Methods and MaterialsIntraluminal pressures and pH were measured concurrently. Four water-filled, open-tip, polyethylene cath-

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The closing mechanism at the gastroesophageal junction

Cited by 55 publications

References 39 publications

Heartburn in Late Pregnancy. Manometric Studies of Esophageal Motor Function*

Heartburn in Late Pregnancy. Manometric Studies of Esophageal Motor Function*

Esophageal Motor Abnormalities Induced by Acid Perfusion in Patients With Heartburn*

Response of the Physiologic Gastroesophageal Sphincter to Increased Intra-abdominal Pressure *

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