| On the pathogenesis of gastroesophageal reflux: the concept of gastroesophageal dyssynergia. | |
| | |
MedLine Citation:
|
PMID: 16077405 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
OBJECTIVES: The cause of lower esophageal sphincter incompetence in gastroesophageal reflux disease is not clearly understood. We investigated the hypothesis that the esophagogastric junction incompetence results from failure of the gastric distention to produce the lower esophageal sphincter and crural diaphragm contraction caused by a disordered reflex action. METHODS: The study was performed in 19 subjects (mean age, 42.6 +/- 7.2 years; 11 men and 8 women) who had reflux esophagitis and hiatus hernia and were scheduled for a fundoplication operation. Eight control volunteers (mean age, 41.8 +/- 6.9; 5 men and 3 women) who had huge supraumbilical ventral hernia but no reflux esophagitis or hiatus hernia were studied during operative hernia repair. The electromyographic activity and pressure response of the lower esophageal sphincter and crural diaphragm to separate esophageal and gastric distention were recorded. RESULTS: In the control subjects (volunteers) esophageal distention caused diminished electromyographic activity of the crural diaphragm and lower esophageal sphincter with decreased esophagogastric junction pressure, whereas gastric distention increased the electromyographic activity of the crural diaphragm and lower esophageal sphincter with increased esophagogastric junction pressure. In the patients the crural diaphragm and lower esophageal sphincter showed diminished resting electromyographic activity, with either no response or a paradoxical response to esophageal or gastric distention. CONCLUSION: The current study has demonstrated that the lower esophageal sphincter and crural diaphragm in patients with gastroesophageal reflux disease exhibited a diminished resting electric activity and either did not respond or reacted paradoxically to esophageal and gastric distention, constituting what we call esophagosphincteric and gastroesophageal paradox or dyssynergia. The cause of lower esophageal sphincter and crural diaphragm dysfunction is not known; a neurogenic cause was proposed. Further studies are required to investigate this point. |
| | |
Authors:
|
Ahmed Shafik; Ismail Shafik; Olfat El-Sibai; Ali A Shafik |
Related Documents
:
|
20425665 - The influence of variable-stiffness guide wires on basal biliary sphincter of oddi pres... 3341525 - The lower esophageal sphincter in health and disease. 8799385 - Alteration of distal esophageal motor functions on different body positions. 9834365 - Physiologic determinants of nocturnal incontinence after ileal pouch-anal anastomosis. 15818035 - Hemoglobin-based oxygen carrier distribution inside vascular wall and arterial pressure... 2710515 - A unifying parameter to describe the clinical mechanics of hydrogel contact lenses. |
Publication Detail:
|
Type: Journal Article |
Journal Detail:
|
Title: The Journal of thoracic and cardiovascular surgery Volume: 130 ISSN: 0022-5223 ISO Abbreviation: J. Thorac. Cardiovasc. Surg. Publication Date: 2005 Aug |
Date Detail:
|
Created Date: 2005-08-03 Completed Date: 2005-10-20 Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 0376343 Medline TA: J Thorac Cardiovasc Surg Country: United States |
Other Details:
|
Languages: eng Pagination: 401-7 Citation Subset: AIM; IM |
Affiliation:
|
Department of Surgery and Experimental Research, Cairo University, Egypt. shafik@ahmed-shafik.org |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adult Diaphragm / physiopathology* Electromyography Esophageal Sphincter, Lower / physiopathology* Esophagogastric Junction / physiopathology* Female Gastroesophageal Reflux / etiology*, physiopathology* Humans Male Middle Aged |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Receptor tyrosine kinase and phosphoinositide-3 kinase signaling in malignant mesothelioma.
Next Document: Surgical salvage therapy for malignant intrathoracic metastases from nonseminomatous germ cell cance...