Abstract
Gastroesophageal reflux is inherently mechanical in nature, driven by the pressure difference between the stomach and the esophagus in the setting of a relaxed or hypotensive sphincter. Recent advances in our understanding of esophagogastric junction (EGJ) biomechanics in the etiology of gastroesophageal reflux disease are highlighted here. We focus this review on three critical areas: the anatomy and physiology of the EGJ that predispose the junction to reflux, the mechanical compliance of the EGJ musculature that has significant pathophysiologic underpinnings, and the trans-sphincteric pressure gradients during gastro-esophageal reflux. We also examine the mechanistic basis of a higher incidence of reflux in obese patients and conclude with some observations on the future of understanding EGJ biomechanics.
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References and Recommended Reading
Mittal RK, Holloway RH, Penagini R, et al.: Transient lower esophageal sphincter relaxation. Gastroenterology 1995, 109:601–610.
Sifrim D, Holloway R: Transient lower esophageal sphincter relaxations: how many or how harmful? Am J Gastroenterol 2001, 96:2529–2532.
Pandolfino JE, Shi G, Trueworthy B, Kahrilas PJ: Esophagogastric junction opening during relaxation distinguishes nonhernia reflux patients, hernia patients, and normal subjects. Gastroenterology 2003, 125:1018–1024.
Kahrilas PJ, Shi G, Manka M, Joehl RJ: Increased frequency of transient lower esophageal sphincter relaxation induced by gastric distention in reflux patients with hiatal hernia. Gastroenterology 2000, 118:688–695.
Grossi L, Ciccaglione AF, Travaglini N, Marzio L: Transient lower esophageal sphincter relaxations and gastroesophageal reflux episodes in healthy subjects and GERD patients during 24 hours. Dig Dis Sci 2001, 46:815–821.
Kahrilas PJ: The role of hiatus hernia in GERD. Yale J Biol Med 1999, 72:101–111.
Ghosh SK, Kahrilas PJ, Lodhia N, Pandolfino JE: Utilizing intraluminal pressure differences to predict esophageal bolus flow dynamics. Am J Physiol Gastrointest Liver Physiol 2007, 293:G1023–G1028.
Ghosh SK, Kahrilas PJ, Zaki T, et al.: The mechanical basis of impaired esophageal emptying postfundoplication. Am J Physiol Gastrointest Liver Physiol 2005, 289:G21–G35.
Brasseur JG, Ulerich R, Dai Q, et al.: Pharmacological dissection of the human gastro-oesophageal segment into three sphincteric components. J Physiol 2007, 580:961–975.
Pandolfino JE, Kim H, Ghosh SK, et al.: High-resolution manometry of the EGJ: an analysis of crural diaphragm function in GERD. Am J Gastroenterol 2007, 102:1056–1063.
Bredenoord AJ, Weusten BL, Timmer R, Smout AJ: Intermittent spatial separation of diaphragm and lower esophageal sphincter favors acidic and weakly acidic reflux. Gastroenterology 2006, 130:334–340.
Pandolfino JE, Curry J, Shi G, et al.: Restoration of normal distensive characteristics of the esophagogastric junction after fundoplication. Ann Surg 2005, 242:43–48.
McMahon BP, Frokjaer JB, Liao D, et al.: A new technique for evaluating sphincter function in visceral organs: application of the functional lumen imaging probe (FLIP) for the evaluation of the oesophago-gastric junction. Physiol Meas 2005, 26:823–836.
McMahon BP, Frokjaer JB, Kunwald P, et al.: The functional lumen imaging probe (FLIP) for evaluation of the esophagogastric junction. Am J Physiol Gastrointest Liver Physiol 2007, 292:G377–G384.
Scheffer RC, Gooszen HG, Hebbard GS, Samsom M: The role of transsphincteric pressure and proximal gastric volume in acid reflux before and after fundoplication. Gastroenterology 2005, 129:1900–1909.
Pandolfino JE, Zhang QG, Ghosh SK, et al.: Transient lower esophageal sphincter relaxations and reflux: mechanistic analysis using concurrent fluoroscopy and high-resolution manometry. Gastroenterology 2006, 131:1725–1733.
El-Serag HB, Ergun GA, Pandolfino J, et al.: Obesity increases oesophageal acid exposure. Gut 2007, 56:749–755.
Bonatti H, Achem SR, Hinder RA: Impact of changing epidemiology of gastroesophageal reflux disease on its diagnosis and treatment. J Gastrointest Surg 2008, 12:373–381.
Jacobson BC, Somers SC, Fuchs CS, et al.: Body-mass index and symptoms of gastroesophageal reflux in women. N Engl J Med 2006, 354:2340–2348.
Merrouche M, Sabate JM, Jouet P, et al.: Gastro-esophageal reflux and esophageal motility disorders in morbidly obese patients before and after bariatric surgery. Obes Surg 2007, 17:894–900.
Pandolfino JE, El-Serag HB, Zhang Q, et al.: Obesity: a challenge to esophagogastric junction integrity. Gastroenterology 2006, 130:639–649.
Ghosh SK, Brasseur JG, Pandolfino JE, Kahrilas PJ: Obesity and GERD: is increased intragastric pressure the mechanism of linkage [abstract]? Gastroenterology 2006, 130:A56.
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Ghosh, S.K. Biomechanics of the esophagogastric junction in gastroesophageal reflux disease. Curr Gastroenterol Rep 10, 246–251 (2008). https://doi.org/10.1007/s11894-008-0051-6
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DOI: https://doi.org/10.1007/s11894-008-0051-6