| The crura and crura-sphincter pressure dynamics in patients with isolated upright and isolated supine reflux. | |
| | |
MedLine Citation:
|
PMID: 11768819 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
The reason why patients with isolated supine reflux do not reflux in the upright position and patients with isolated upright reflux do not reflux in the supine position is unknown. Our objective was to determine the characteristics of the crura, lower esophageal sphincter, crura-sphincter dynamics, and esophageal body on manometry, endoscopy, and X-ray in patients with isolated upright and isolated supine reflux. Eighty consecutive patients with isolated upright reflux were compared with 82 consecutive patients with isolated supine reflux. Manometrically there was no difference in lower esophageal sphincter characteristics and esophageal contractions between the two groups. The prevalence of a hiatal hernia on manometry was similar between upright and supine refluxers (88% vs 88%). Upright refluxers had shorter hiatal hernias [median (interquartile range) 1.1 (0.65-1.8) vs 1.2 (1-2.3), P < 0.046)]. The median crural pressure, crura-sphincter pressure gradient, and crura-sphincter pressure ratio in upright refluxers was 14.96 (9.5-21.27), 3.28 (1.7-12.2), and 1.33 (0.87-2.8) mm Hg, respectively. These values were significantly higher (P < 0.001) in supine refluxers at 21.43 (16.6-29.9), 10.66 (4.3-19.7), and 2.1 (1.3-4.2) mm Hg, respectively. We conclude that the significantly higher crural pressure in patients with supine reflux acts as a mechanical ring and as a physiologic protector against the unfolding of the sphincter in the postprandial and upright periods. Higher crura-sphincter pressure gradient and larger-size hiatal hernias in patients with supine reflux results in pressurization of the hernia sac and subsequent reflux when these patients are in a supine position. |
| | |
Authors:
|
F Banki; R J Mason; J A Hagen; C G Bremner; C G Streets; J H Peters; T R DeMeester |
Related Documents
:
|
19954879 - Prevalence of temporomandibular disorders in patients with gastroesophageal reflux dise... 11805419 - Megaprepuce associated with vesicoureteric reflux. 21151549 - Intussusception caused by yersinia enterocolitica enterocolitis in a patient with sickl... 6345129 - Metoclopramide. an updated review of its pharmacological properties and clinical use. 15659129 - The need of mycophenolic acid monitoring in long-term renal transplants. 30679 - Gastroesophageal reflux and bleeding esophageal varices. 12220699 - Interleukin-10 promoter polymorphisms in patients with multiple sclerosis. 2444929 - Phenytoin in the treatment of inducible ventricular tachycardia: results of electrophys... 20606449 - Biochemical aspirin resistance and recurrent lesions in patients with acute ischemic st... |
Publication Detail:
|
Type: Journal Article |
Journal Detail:
|
Title: The American surgeon Volume: 67 ISSN: 0003-1348 ISO Abbreviation: Am Surg Publication Date: 2001 Dec |
Date Detail:
|
Created Date: 2001-12-21 Completed Date: 2002-01-10 Revised Date: 2004-11-17 |
Medline Journal Info:
|
Nlm Unique ID: 0370522 Medline TA: Am Surg Country: United States |
Other Details:
|
Languages: eng Pagination: 1150-6 Citation Subset: IM |
Affiliation:
|
Keck School of Medicine, University of Southern California, Los Angeles 90033, USA. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Esophagus
/
physiopathology* Female Gastroesophageal Reflux / diagnosis, physiopathology* Hernia, Hiatal / physiopathology Humans Hydrogen-Ion Concentration Male Manometry Middle Aged Monitoring, Ambulatory Supine Position / physiology* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Intravenous interleukin-6 levels predict need for laparotomy in patients with bowel obstruction.
Next Document: The topography of colorectal cancer varies by race/ethnicity and affects the utility of flexible sig...