| The impact of gastric distension on the lower esophageal sphincter and its exposure to acid gastric juice. | |
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MedLine Citation:
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PMID: 20562610 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND AND AIMS: The lower esophageal sphincter (LES) in patients with gastroesophageal reflux disease often has a low resting pressure and a short abdominal length. The mechanism by which this occurs is unknown. We hypothesize that gastric distension causes progressive effacement of the abdominal portion of the LES, exposing it to acid injury resulting in mucosal and sphincter damage. Our aim was to assess in normal subjects the effect of gastric distension on the LES length and pressure and its exposure to acid gastric juice. METHODS: Eleven asymptomatic volunteers had their LES length and pressure measured before and during gastric distension. The location of the pH step-up point (shift from gastric pH to a pH >4) was also measured before and after distension. RESULTS: Progressive gastric distension with air resulted in progressive shortening of LES (R = 0.89, P < 0.0001). After infusion of 750 cc of air there was a significant reduction in the median LES length from 4 to 2.6 cm (P = 0.001). This change occurred in the abdominal length of the LES (2.6-1.4 cm [P = 0.001]) and not in the thoracic length. At rest the pH step-up point was 0.5 cm above the lower border of the LES and with distension moved a median of 1 cm cephalad within the LES. Simultaneously with the loss of length there was a reduction in LES pressure (27.4-23.4 mm Hg, P = 0.02). CONCLUSIONS: Gastric distension causes progressive shortening of the abdominal length of the LES and a reduction in its pressure. The process exposes the effaced mucosa and sphincter to acid gastric juice. |
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Authors:
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Shahin Ayazi; Anand Tamhankar; Steven R DeMeester; Joerg Zehetner; Calvin Wu; John C Lipham; Jeffrey A Hagen; Tom R DeMeester |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Annals of surgery Volume: 252 ISSN: 1528-1140 ISO Abbreviation: Ann. Surg. Publication Date: 2010 Jul |
Date Detail:
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Created Date: 2010-06-23 Completed Date: 2010-07-12 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0372354 Medline TA: Ann Surg Country: United States |
Other Details:
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Languages: eng Pagination: 57-62 Citation Subset: AIM; IM |
Affiliation:
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Division of Thoracic and Foregut Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Esophageal Sphincter, Lower / anatomy & histology, physiology* Female Gastric Acidity Determination Gastric Juice / physiology* Humans Male Middle Aged Pressure Stomach / physiology* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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