The Nature and Location of Lower Esophageal Ring

Goyal, Raj K.; Bauer, James L.; Spiro, Howard M.

doi:10.1056/nejm197105272842103

Cited by 82 publications

(28 citation statements)

References 12 publications

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“…It is well known that the LES contributes significantly to the prevention of gastric reflux into the esophagus [5][6][7]. However, the mechanism of gastroesophageal competence is vague and incompletely understood [6][7][8][9].…”

Section: Mechanism Of Gastroesophageal Competencementioning

confidence: 99%

“…The esophagus transports food and fluid from the pharynx to the stomach. A sphincteric action exists within the lower 4 cm of the esophagus which prevents reflux of gastric contents into esophagus [5,6]. The mechanism of gastroesophageal competence is complex and incompletely understood [6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

“…A sphincteric action exists within the lower 4 cm of the esophagus which prevents reflux of gastric contents into esophagus [5,6]. The mechanism of gastroesophageal competence is complex and incompletely understood [6][7][8][9]. A true anatomic sphincter could not be demonstrated at the lower end of the esophagus, and the sphincter is considered a physiological one [10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

“…Cholinergic and ·-adrenergic stimuli enhance and ß-adrenergic stimuli inhibit sphincter contraction [14]. The LES contributes to the prevention of gastric reflux into the esophagus [5][6][7]; however, the mechanism of action is not exactly known [6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

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Recognition of a Gastroesophageal Reflex in Dogs and Its Role in Lower Esophageal Sphincter Competence

Shafik

1998

Eur Surg Res

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The present communication describes a reflex which we call ‘gastroesophageal reflex’ and discusses its significance. Fourteen dogs were anesthetized, and two balloon-tipped catheters were introduced: one in the stomach and the other one in the lower esophageal sphincter (LES). The LES pressure response to gastric distension with a balloon filled with H₂O in increments of 10 ml up to 100 ml and to the increase of the intra-abdominal pressure (IAP) was recorded. The gastric pressure response to LES distension with water in increments of 2, 4, and 6 ml was also registered. Gastric distension led to LES pressure increase; the greater the gastric distension, the higher the LES pressure increase. An increase of the IAP, too, effected the LES pressure increase. In contrast, LES distension caused insignificant gastric pressure changes. The results were reproducible. The constant response of the LES to gastric distension as well as the reproducibility postulate a reflex relationship between the two actions. We call this relationship ‘gastroesophageal reflex’. This reflex is suggested to play an important role in prevention of gastroesophageal reflux. It tightens the LES upon increase of gastric or IAP pressure. This is important in cases of full stomach or during coughing, sneezing, or straining at defecation or micturition. The ‘reflex theory’ is advanced to explain the mechanism of gastroesophageal competence. It seems that the gastroesophageal reflex, rather than the pressure of a controversial anatomical LES, is responsible for gastroesophageal competence. The reflex may prove to be of diagnostic significance in gastroesophageal competence disorders.

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Section: Mechanism Of Gastroesophageal Competencementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Recognition of a Gastroesophageal Reflex in Dogs and Its Role in Lower Esophageal Sphincter Competence

Shafik

1998

Eur Surg Res

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“…The normal esophageal diameter is between 20 mm and 30 mm, but if the diameter is less than 12 mm, dysphagia symptoms begin to occur (3,4). The esophageal diameter must be at least 15 mm for symptomatic healing to occur.…”

mentioning

confidence: 99%