Mechanisms of EGJ dysfunction in GERD

Heartburn and Acid Reflux Cure Program

Most Effective Acid Reflux Treatment

Get Instant Access

Reflux occurs with either intermittent or constant compromise of the EGJ high-pressure zone. An added element to EGJ competence is EGJ opening and the degree to which the EGJ opens during periods in which the high-pressure zone is compromised. Just as with the upper esophageal sphincter, it has become apparent that sphincter opening is not synonymous with sphincter relaxation. During swallowing, despite being neurally inhibited, the EGJ must open to facilitate the esophago-gastric flow of a swallowed bolus while at the same time intermittently closing to prevent reflux of gastric contents into esophagus. During rest the EGJ must contain gastric juice but also be able to transiently relax and open enough to selectively permit gas venting without allowing reflux of caustic gastric juice. These functions are accomplished by the delicate interplay of the anatomical components and physiological responses of the EGJ. The dominant mechanism protecting against reflux will vary with physiological circumstance. For example, the intra-abdominal segment of the LES may be important in preventing reflux associated with swallowing, the crural diaphragmatic may be of primary importance during episodes of increased intra-gastric pressure, and basal LES pressure may be of cardinal importance during sleep. As these protective

Grade I

Grade I

Grade I

Grade IV

Grade I

Grade I

Grade I

Grade IV

Normal ridge of tissue closely approximated to the scope

Ridge is slightly I ess well defined and opens with respiration

Ridge is effaced and the hiatus is patulous

Hiatus is wide open at all times and displaced axially

Fig. 6. Three-dimensional representation of the progressive anatomical disruption of the gastroesophageal flap valve along with corresponding endoscopy photos (Grade I). Normal ridge of tissue closely approximated to the shaft of the retroflexed scope (Grade II).The ridge is slightly less well defined and opens with respiration (Grade III). The ridge is barely present and the hiatus is patulous (Grade IV).There is no muscular ridge and the hiatus is wide open at all times (Modified from [28]: Hill LD, Kozarek RA, Kraemer SJ etal (1986) The gastroesophageal flap valve: in vitro and in vivo observations. Gastrointest Endosc 44: 541-547, with permission)

Normal ridge of tissue closely approximated to the scope

Ridge is slightly I ess well defined and opens with respiration

Ridge is effaced and the hiatus is patulous

Hiatus is wide open at all times and displaced axially

Fig. 6. Three-dimensional representation of the progressive anatomical disruption of the gastroesophageal flap valve along with corresponding endoscopy photos (Grade I). Normal ridge of tissue closely approximated to the shaft of the retroflexed scope (Grade II).The ridge is slightly less well defined and opens with respiration (Grade III). The ridge is barely present and the hiatus is patulous (Grade IV).There is no muscular ridge and the hiatus is wide open at all times (Modified from [28]: Hill LD, Kozarek RA, Kraemer SJ etal (1986) The gastroesophageal flap valve: in vitro and in vivo observations. Gastrointest Endosc 44: 541-547, with permission)

mechanisms are compromised, the deleterious effect is additive resulting in an increasing number of reflux events and consequently an increased amount of esophageal acid exposure.

Investigations have focused on three dominant mechanisms of EGJ incompetence (1) transient LES relaxations, without anatomic abnormality, (2) LES hypotension, again without anatomic abnormality, or (3) anatomical and mechanical distortion of the EGJ inclusive of, but not limited to, hiatus hernia. Which reflux mechanism dominates depends upon a number of factors, the most important being the anatomy of the EGJ.

Was this article helpful?

0 0
Herbal Remedies For Acid Reflux

Herbal Remedies For Acid Reflux

Gastroesophageal reflux disease is the medical term for what we know as acid reflux. Acid reflux occurs when the stomach releases its liquid back into the esophagus, causing inflammation and damage to the esophageal lining. The regurgitated acid most often consists of a few compoundsbr acid, bile, and pepsin.

Get My Free Ebook


Post a comment