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Abnormal structure and function of the esophagogastric junction and proximal stomach in gastroesophageal reflux disease.
Am J Gastroenterol. 2014 May; 109(5):658-67.AJ

Abstract

OBJECTIVES

This study applies concurrent magnetic resonance imaging (MRI) and high-resolution manometry (HRM) to test the hypothesis that structural factors involved in reflux protection, in particular, the acute insertion angle of the esophagus into the stomach, are impaired in gastroesophageal reflux disease (GERD) patients.

METHODS

A total of 24 healthy volunteers and 24 patients with mild-moderate GERD ingested a test meal. Three-dimensional models of the esophagogastric junction (EGJ) were reconstructed from MRI images. Measurements of the esophagogastric insertion angle, gastric orientation, and volume change were obtained. Esophageal function was assessed by HRM. Number of reflux events and EGJ opening during reflux events were assessed by HRM and cine-MRI. Statistical analysis applied mixed-effects modeling.

RESULTS

The esophagogastric insertion angle was wider in GERD patients than in healthy subjects (+7° ± 3°; P=0.03). EGJ opening during reflux events was greater in GERD patients than in healthy subjects (19.3 mm vs. 16.8 mm; P=0.04). The position of insertion and gastric orientation within the abdomen were also altered (both P<0.05). Median number of reflux events was 3 (95% CI: 2.5-4.6) in GERD and 2 (95% CI: 1.8-3.3) in healthy subjects (P=0.09). Lower esophageal sphincter (LES) pressure was lower (-11 ± 2 mm Hg; P<0.0001) and intra-abdominal LES length was shorter (-1.0 ± 0.3 cm, P<0.0006) in GERD patients.

CONCLUSIONS

GERD patients have a wider esophagogastric insertion angle and have altered gastric morphology; structural changes that could compromise reflux protection by the "flap valve" mechanism. In addition, the EGJ opens wider during reflux in GERD patients than in healthy volunteers: an effect that facilitates volume reflux of gastric contents.

Authors+Show Affiliations

1] Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland [2] Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.Department of Biological Sciences and Bioengineering, Indian Institute of Technology, Kanpur, India.Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.Menne Biomed, Tuebingen, Germany.Division of Gastroenterology, Royal Melbourne Hospital, Melbourne, Australia.Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland.1] Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland [2] Zurich Centre for Integrative Human Physiology (ZIHP), Zurich, Switzerland.1] Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland [2] Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.1] Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland [2] Zurich Centre for Integrative Human Physiology (ZIHP), Zurich, Switzerland.1] Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland [2] Zurich Centre for Integrative Human Physiology (ZIHP), Zurich, Switzerland.Department of Biological Sciences and Bioengineering, Indian Institute of Technology, Kanpur, India.1] Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland [2] Nottingham Digestive Diseases Centre and Biomedical Research Unit, University Hospital, Nottingham, UK.

Pub Type(s)

Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24589669

Citation

Curcic, Jelena, et al. "Abnormal Structure and Function of the Esophagogastric Junction and Proximal Stomach in Gastroesophageal Reflux Disease." The American Journal of Gastroenterology, vol. 109, no. 5, 2014, pp. 658-67.
Curcic J, Roy S, Schwizer A, et al. Abnormal structure and function of the esophagogastric junction and proximal stomach in gastroesophageal reflux disease. Am J Gastroenterol. 2014;109(5):658-67.
Curcic, J., Roy, S., Schwizer, A., Kaufman, E., Forras-Kaufman, Z., Menne, D., Hebbard, G. S., Treier, R., Boesiger, P., Steingoetter, A., Fried, M., Schwizer, W., Pal, A., & Fox, M. (2014). Abnormal structure and function of the esophagogastric junction and proximal stomach in gastroesophageal reflux disease. The American Journal of Gastroenterology, 109(5), 658-67. https://doi.org/10.1038/ajg.2014.25
Curcic J, et al. Abnormal Structure and Function of the Esophagogastric Junction and Proximal Stomach in Gastroesophageal Reflux Disease. Am J Gastroenterol. 2014;109(5):658-67. PubMed PMID: 24589669.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Abnormal structure and function of the esophagogastric junction and proximal stomach in gastroesophageal reflux disease. AU - Curcic,Jelena, AU - Roy,Shammodip, AU - Schwizer,Alexandra, AU - Kaufman,Elad, AU - Forras-Kaufman,Zsofia, AU - Menne,Dieter, AU - Hebbard,Geoffrey S, AU - Treier,Reto, AU - Boesiger,Peter, AU - Steingoetter,Andreas, AU - Fried,Michael, AU - Schwizer,Werner, AU - Pal,Anupam, AU - Fox,Mark, Y1 - 2014/03/04/ PY - 2013/08/26/received PY - 2014/01/27/accepted PY - 2014/3/5/entrez PY - 2014/3/5/pubmed PY - 2014/6/24/medline SP - 658 EP - 67 JF - The American journal of gastroenterology JO - Am. J. Gastroenterol. VL - 109 IS - 5 N2 - OBJECTIVES: This study applies concurrent magnetic resonance imaging (MRI) and high-resolution manometry (HRM) to test the hypothesis that structural factors involved in reflux protection, in particular, the acute insertion angle of the esophagus into the stomach, are impaired in gastroesophageal reflux disease (GERD) patients. METHODS: A total of 24 healthy volunteers and 24 patients with mild-moderate GERD ingested a test meal. Three-dimensional models of the esophagogastric junction (EGJ) were reconstructed from MRI images. Measurements of the esophagogastric insertion angle, gastric orientation, and volume change were obtained. Esophageal function was assessed by HRM. Number of reflux events and EGJ opening during reflux events were assessed by HRM and cine-MRI. Statistical analysis applied mixed-effects modeling. RESULTS: The esophagogastric insertion angle was wider in GERD patients than in healthy subjects (+7° ± 3°; P=0.03). EGJ opening during reflux events was greater in GERD patients than in healthy subjects (19.3 mm vs. 16.8 mm; P=0.04). The position of insertion and gastric orientation within the abdomen were also altered (both P<0.05). Median number of reflux events was 3 (95% CI: 2.5-4.6) in GERD and 2 (95% CI: 1.8-3.3) in healthy subjects (P=0.09). Lower esophageal sphincter (LES) pressure was lower (-11 ± 2 mm Hg; P<0.0001) and intra-abdominal LES length was shorter (-1.0 ± 0.3 cm, P<0.0006) in GERD patients. CONCLUSIONS: GERD patients have a wider esophagogastric insertion angle and have altered gastric morphology; structural changes that could compromise reflux protection by the "flap valve" mechanism. In addition, the EGJ opens wider during reflux in GERD patients than in healthy volunteers: an effect that facilitates volume reflux of gastric contents. SN - 1572-0241 UR - https://www.unboundmedicine.com/medline/citation/24589669/Abnormal_structure_and_function_of_the_esophagogastric_junction_and_proximal_stomach_in_gastroesophageal_reflux_disease_ L2 - http://Insights.ovid.com/pubmed?pmid=24589669 DB - PRIME DP - Unbound Medicine ER -