Document Detail

The normal antireflux mechanism.
MedLine Citation:
PMID:  11787959     Owner:  NLM     Status:  MEDLINE    
The normal antireflux mechanism consists of several components, any one of which may malfunction and render an individual prone to the development of GERD. The LES is clearly the most important component because gastroesophageal reflux almost always occurs when the sphincter pressure equals that of the stomach. Usually, an LES pressure of just 2 to 3 mm Hg above intragastric pressure is sufficient to prevent reflux. Other factors certainly play significant ancillary roles in preventing reflux. In the absence of a hiatal hernia, the crural fibers of the diaphragm serve as an "extrinsic" sphincter. Furthermore, the unique anatomy of the proximal stomach (e.g., the angle of His, mucosal flap valve, posterolateral location of the fundus) serves to keep gastric contents away from the gastroesophageal junction, making it less likely for reflux to occur when the LES relaxes. When a hiatal hernia is present, these factors are lost, and the hernia sac provides a reservoir for gastric juices with ready access to the LES. Finally, some degree of reflux occurs in all individuals, but esophageal clearance and acid neutralization provide an important last line of defense.
W G Paterson
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Chest surgery clinics of North America     Volume:  11     ISSN:  1052-3359     ISO Abbreviation:  Chest Surg. Clin. N. Am.     Publication Date:  2001 Aug 
Date Detail:
Created Date:  2002-01-11     Completed Date:  2002-05-28     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  9208495     Medline TA:  Chest Surg Clin N Am     Country:  United States    
Other Details:
Languages:  eng     Pagination:  473-83     Citation Subset:  IM    
Queen's University, Hotel Dieu Hospital, Kingston, Ontario, Canada.
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MeSH Terms
Esophagogastric Junction / anatomy & histology*,  physiology*
Gastroesophageal Reflux / physiopathology*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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