Skip to main content
SpringerLink
Log in

Defective Mucosal Movement at the Gastroesophageal Junction in Patients with Gastroesophageal Reflux Disease

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

Little is known about the role of muscularis mucosa at the gastroesophageal junction (GEJ).

Aim

To evaluate the movement of the mucosa/muscularis-mucosa/submucosa (MMS) at the GEJ in normal subjects and in patients with gastroesophageal reflux disease (GERD).

Methods

Gastroesophageal junctions of 20 non-GERD subjects and 10 patients with GERD were evaluated during 5 mL swallows using two methods: in high-resolution endoluminal ultrasound and manometry, the change in the GEJ luminal pressures and cross-sectional area of esophageal wall layers were measured; in abdominal ultrasound, the MMS movement at the GEJ was analyzed.

Results

Endoluminal ultrasound: In the non-GERD subjects, the gastric MMS moved rostrally into the distal esophagus at 2.17 s after the bolus first reached the GEJ. In GERD patients, the gastric MMS did not move rostrally into the distal esophagus. The maximum change in cross-sectional area of gastroesophageal MMS in non-GERD subjects and in GERD patients was 289 % and 183 %, respectively. Abdominal ultrasound: In non-GERD subjects, the gastric MMS starts to move rostrally significantly earlier and to a greater distance than muscularis propria (MP) after the initiation of the swallow (1.75 vs. 3.00 s) and (13.97 vs. 8.91 mm). In GERD patients, there is no significant difference in the movement of gastric MMS compared to MP (6.74 vs. 6.09 mm). The independent movement of the gastric MMS in GERD subjects was significantly less than in non-GERD subjects.

Conclusion

In non-GERD subjects, the gastric MMS moves rostrally into the distal esophagus during deglutitive inhibition and forms a barrier. This movement of the MMS is defective in patients with GERD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Freeman WH. An atlas of histology [by] w. H. Freeman and brian bracegirdle. New York, Dover Publications; 1966.

  2. Brasseur JG, Nicosia MA, Pal A, Miller LS. Function of longitudinal vs circular muscle fibers in esophageal peristalsis, deduced with mathematical modeling. World J Gastroenterol. 2007;13:1335–1346.

    Article  PubMed  Google Scholar 

  3. Dodds WJ, Stewart ET, Hodges D, Zboralske FF. Movement of the feline esophagus associated with respiration and peristalsis. An evaluation using tantalum markers. J Clin Invest. 1973;52:1–13.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  4. Edmundowicz SA, Clouse RE. Shortening of the esophagus in response to swallowing. Am J Physiol. 1991;260:G512–G516.

    CAS  PubMed  Google Scholar 

  5. Ghosh SK, Kahrilas PJ, Zaki T, Pandolfino JE, Joehl RJ, Brasseur JG. The mechanical basis of impaired esophageal emptying post-fundoplication. Am J Physiol Gastrointest Liver Physiol. 2005;289:G21–G35.

    Article  CAS  PubMed  Google Scholar 

  6. Kahrilas PJ, Wu S, Lin S, Pouderoux P. Attenuation of esophageal shortening during peristalsis with hiatus hernia. Gastroenterology. 1995;109:1818–1825.

    Article  CAS  PubMed  Google Scholar 

  7. Nicosia MA, Brasseur JG, Liu JB, Miller LS. Local longitudinal muscle shortening of the human esophagus from high-frequency ultrasonography. Am J Physiol Gastrointest Liver Physiol. 2001;281:G1022–G1033.

    CAS  PubMed  Google Scholar 

  8. Pal A, Brasseur JG. The mechanical advantage of local longitudinal shortening on peristaltic transport. J Biomech Eng. 2002;124:94–100.

    Article  PubMed  Google Scholar 

  9. Pouderoux P, Lin S, Kahrilas PJ. Timing, propagation, coordination, and effect of esophageal shortening during peristalsis. Gastroenterology. 1997;112:1147–1154.

    Article  CAS  PubMed  Google Scholar 

  10. Miller L, Dai Q, Korimilli A, Levitt B, Ramzan Z, Brasseur J. Use of endoluminal ultrasound to evaluate gastrointestinal motility. Dig Dis. 2006;24:319–341.

    Article  PubMed  Google Scholar 

  11. Adrain AL, Ter HC, Cassidy MJ, Schiano TD, Liu JB, Miller LS. High-resolution endoluminal sonography is a sensitive modality for the identification of Barrett’s metaplasia. Gastrointest Endosc. 1997;46:147–151.

    Article  CAS  PubMed  Google Scholar 

  12. Chen MH, Kikuchi Y, Chu BC, Kishimoto R, Choji K, Miyasaka K. Demonstration of the distal end of the oesophagus by transabdominal ultrasound. Br J Radiol. 1997;70:1215–1221.

    Article  CAS  PubMed  Google Scholar 

  13. DeMeester TR, Peters JH, Bremner CG, Chandrasoma P. Biology of gastroesophageal reflux disease: pathophysiology relating to medical and surgical treatment. Annu Rev Med. 1999;50:469–506.

    Article  CAS  PubMed  Google Scholar 

  14. Schiffner BJ. Opening stiffness of the esophago-gastric segment in health, with GERD, and after endoscopic surgery. Mechanical and Nuclear Engineering, Pennsylvania State University, 2004, Mechanical Engineering, pp 123.

  15. Sifrim D, Janssens J, Vantrappen G. A wave of inhibition precedes primary peristaltic contractions in the human esophagus. Gastroenterology. 1992;103:876–882.

    CAS  PubMed  Google Scholar 

  16. Meneghetti AT, Tedesco P, Damani T, Patti MG. Esophageal mucosal damage may promote dysmotility and worsen esophageal acid exposure. J Gastrointest Surg. 2005;9:1313–1317.

    Article  PubMed  Google Scholar 

  17. Rieder F, Biancani P, Harnett K, Yerian L, Falk GW. Inflammatory mediators in gastroesophageal reflux disease: impact on esophageal motility, fibrosis, and carcinogenesis. Am J Physiol Gastrointest Liver Physiol. 2010;298:G571–G581.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported by a National Institutes of Health grant award # R01 DK079954 from the National Institute of Diabetes and Digestive and Kidney Diseases to Michael R Ruggieri and Larry Miller.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Medicine (Gastroenterology), The Feinstein Institute for Medical Research, Hofstra North Shore-LIJ School of Medicine, 350 Community Drive, Manhasset, NY, 11030, USA

    Anil K. Vegesna

  2. Department of Medicine (Gastroenterology), Temple University Hospital, 3401N Broad Street, Philadelphia, PA, 19140, USA

    Hemal Patel, Samuel Weissman, Sushma Indukuri, Anitha Nimma & Qing Dai

  3. School of Medicine, Temple University, 3401N Broad Street, Philadelphia, PA, 19140, USA

    Anand Patel

  4. Department of Physics, Temple University, 1801N Broad St, Philadelphia, PA, 19122, USA

    Matthew Kissel

  5. Department of Medicine, North shore University Hospital, Hofstra North Shore-LIJ School of Medicine, 300 Community Drive, Manhasset, NY, 11030, USA

    Larry S. Miller

Authors
  1. Anil K. Vegesna
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hemal Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Samuel Weissman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anand Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Matthew Kissel
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sushma Indukuri
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Anitha Nimma
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Qing Dai
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Larry S. Miller
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Larry S. Miller.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 12 kb)

Supplementary material 2 (WMV 1923 kb)

Supplementary material 3 (WMV 2622 kb)

Supplementary material 4 (WMV 7814 kb)

Supplementary material 5 (WMV 3744 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Vegesna, A.K., Patel, H., Weissman, S. et al. Defective Mucosal Movement at the Gastroesophageal Junction in Patients with Gastroesophageal Reflux Disease. Dig Dis Sci 59, 1870–1877 (2014). https://doi.org/10.1007/s10620-014-3091-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-014-3091-9

Keywords

Search

Navigation