Esophagogastric Junction Contractile Integral (EGJ-CI) in Various Phenotypes of Gastroesophageal Reflux Disease (GERD)

Introduction: Two parameters of high-resolution esophageal manometry are used to observe the function of the esophagogastric junction (EGJ): the anatomical morphology of the EGJ and contractile vigor, which is evaluated with the esophagogastric junction contractile integral (EGJ-CI). To date, how these parameters behave in different gastroesophageal reflux disease (GERD) phenotypes has not been evaluated. Materials and methods: An analytical observational study evaluated patients with GERD confirmed by pH-impedance testing and endoscopy undergoing high-resolution esophageal manometry. The anatomical morphology of the EGJ and EGJ-CI was assessed and compared between reflux phenotypes: acid, non-acid, erosive, and non-erosive. Results: 72 patients were included (63% women, mean age: 54.9 years), 81.9% with acid reflux and 25% with erosive esophagitis. In the latter, a decrease in EGJ-CI (median: 15.1 vs. 23, p = 0.04) and a more significant proportion of patients with type IIIa and IIIb EGJ (83.3% vs 37.1%, p < 0.01) were found. No significant differences existed in the manometric parameters of patients with and without acid and non-acid reflux. Conclusion: In our population, EGJ-CI significantly decreased in patients with erosive GERD, suggesting that it could be used to predict this condition in patients with GERD. This finding is also related to a higher proportion of type III EGJ and lower pressure at end-inspiration of the lower esophageal sphincter in this reflux type.

Introducción: Para observar la función de la unión esofagogástrica (UEG) se utilizan dos parámetros de la manometría esofágica de alta resolución: la morfología anatómica de la UEG y el vigor contráctil, el cual se evalúa con la integral de contractilidad distal de la unión esofagogástrica (IC-UEG). Hasta el momento, no se ha evaluado cómo se comportan estos parámetros en los diferentes fenotipos de enfermedad por reflujo gastroesofágico (ERGE). Metodología: Estudio observacional analítico en el que se evaluaron pacientes con ERGE confirmado por pH-impedanciometría y endoscopia, llevados a manometría esofágica de alta resolución. Se evaluó la morfología anatómica de la UEG y la IC-UEG, y se comparó entre los diferentes fenotipos de reflujo: ácido, no ácido, erosivo y no erosivo. Resultados: Se incluyó a 72 pacientes (63% mujeres, edad media: 54,9 años), 81,9% con reflujo ácido y 25% con esofagitis erosiva. En este último grupo se encontró una disminución de la IC-UEG (mediana: 15,1 frente a 23, p = 0,04) y una mayor proporción de pacientes con UEG tipo IIIa y IIIb (83,3% frente a 37,1%, p < 0,01). No se encontraron diferencias significativas en los parámetros manométricos de los pacientes con y sin reflujo ácido y no ácido. Conclusión: En nuestra población, la IC-UEG estuvo significativamente disminuida en los pacientes con ERGE erosivo, lo que sugiere que podría ser utilizada como un predictor de esta condición en pacientes con ERGE. Este hallazgo también se relaciona con mayor proporción de UGE tipo III y menor presión al final de la inspiración del esfínter esofágico inferior en este tipo de reflujo.

Impacto de la cardiomiotomía laparoscópica de Heller en la función del esfínter esofágico inferior y el diámetro del esófago / Impact of laparoscopic Heller cardiomyotomy on lower esophageal sphincter function and esophageal diameter

Introducción. La acalasia es un trastorno motor del esófago caracterizado por la ausencia de peristalsis y la alteración en la relajación del esfínter esofágico inferior. La cardiomiotomía laparoscópica de Heller más funduplicatura parcial es el tratamiento estándar. La mejoría sintomática ha sido bien documentada, pero no hay suficiente información objetiva respecto a los cambios fisiológicos y radiográficos luego del procedimiento. Métodos. Estudio de cohorte bidireccional de pacientes llevados a cardiomiotomía laparoscópica de Heller, entre los años 2018 y 2021, en el Hospital Universitario San Vicente Fundación de Medellín, Colombia. Se describen variables demográficas y clínicas. Se realizaron puntaje sintomático de Eckardt, manometría esofágica y radiografía de esófago en el pre y postoperatorio. Se hizo comparación de síntomas, presión basal del esfínter esofágico inferior, presión de relajación integrada y diámetro del esófago antes y después de la intervención. Resultados. Se incluyeron 24 pacientes. El 63 % fueron mujeres y la edad promedio fue de 44 años. Los valores promedio preoperatorios vs postoperatorios fueron: puntaje de Eckardt 10,6 vs 1,4 puntos (p<0,001), presión basal de 41,4 vs 18,1 mmHg (p=0,004) y presión de relajación integrada de 28,6 vs 12,5 mmHg (p=0,001). El diámetro del esófago no presentó cambios. No hubo correlación de síntomas con los cambios de presión del esfínter esofágico inferior. El tiempo de seguimiento fue de 20 meses. Conclusiones. La cardiomiotomía de Heller es un procedimiento altamente efectivo para el tratamiento definitivo de la acalasia, logrando una mejoría subjetiva y objetiva basada en síntomas y en parámetros de manometría, respectivamente

Introduction. Achalasia is a motor disorder of the esophagus characterized by the absence of peristalsis and impaired relaxation of the lower esophageal sphincter. Laparoscopic Heller ́s cardiomyotomy plus partial fundoplication is the standard treatment. Symptomatic improvement has been well documented, but there is insufficient objective information regarding physiologic and radiographic changes after the procedure. Methods. Bidirectional cohort study of patients underwent laparoscopic Heller ́s cardiomyotomy between 2018 and 2021 at the San Vicente Fundación University Hospital in Medellín, Colombia. Demographic and clinical variables are described. Eckardt symptom score, esophageal manometry, and esophageal radiography were performed pre and postoperatively. A comparison of symptoms, baseline lower esophageal sphincter pressure, integrated relaxation pressure, and esophageal diameter before and after intervention were performed.Results. 24 patients were included. 63% were women and the average age was 44 years. The preoperative vs. postoperative mean values were: Eckardt score 10.6 vs. 1.4 points (p<0.001), basal pressure of 41.4 vs. 18.1 mmHg (p=0.004) and integrated relaxation pressure of 28.6 vs. 12.5 mmHg (p=0.001). The diameter of the esophagus did not present changes. There was no correlation of symptoms with lower esophageal sphincter pressure changes. The follow-up time was 20 months. Conclusions. Heller cardiomyotomy is a highly effective procedure for the definitive treatment of achalasia, achieving subjective and objective improvements, based on symptoms and manometry parameters, respectively

Clinical factors influencing the effect of anti-reflux surgery for gastroesophageal reflux disease / 中华普通外科杂志

Objective:to analyze the risk factors for the side effect of anti-reflux surgery for gastroesophageal reflux disease (GERD) with regards to relief of reflux symptom, dysphagia and postoperative satisfaction.Method:The incidence of disappointing chief complaint among 192 patients who underwent anti-reflux surgery was analyzed. The related independent risk factors were identified by multivariate analysis.Results:The incidence of non-relief of reflux symptom was approximately 21.8% (42 cases), of which the risk factors were identified as preoperative depression and long-term PPI administration. The incidence of persistent dysphagia was 7.3% (14 cases), of which the risk factors were identified as preoperative depression and weak peristalsis of esophageal body. The incidence of postoperative dissatisfaction was 26.0% (50 cases), of which the risk factors were identified as long-term PPI administration and moderate-severe depression. The GERD patients with hiatal hernia and low pressure of lower esophageal sphincter were more likely benefit from anti-reflux surgery and had a higher postoperative satisfaction rate.Conclusion:Hiatal hernia and low pressure of lower esophageal sphincter are the favorable factors predicting good result of anti-reflux surgery. Long-term PPI administration and preoperative depression is an indication for poor result of anti-reflux surgery.

Validation of a new water-perfused high-resolution manometry system / Validação de um novo sistema de manometria de alta resolução por perfusão de água

ABSTRACT Background: High-resolution manometry is more costly but clinically superior to conventional manometry. Water-perfused systems may decrease costs, but it is unclear if they are as reliable as solid-state systems, and reference values are interchangeable. Aim: To validate normal values for a new water-perfusion high-resolution manometry system. Methods: Normative values for a 24-sensors water perfused high-resolution manometry system were validated by studying 225 individuals who underwent high resolution manometry for clinical complaints. Patients were divided in four groups: group 1 - gastroesophageal reflux disease; group 2 - achalasia; group 3 - systemic diseases with possible esophageal manifestation; and group 4 - dysphagia. Results: In group 1, a hypotonic lower esophageal sphincter was found in 49% of individuals with positive 24 h pH monitoring, and in 28% in pH-negative individuals. In groups 2 and 3, aperistalsis was found in all individuals. In group 4, only one patient (14%) had normal high-resolution manometry. Conclusions: The normal values determined for this low-cost water-perfused HRM system with unique peristaltic pump and helicoidal sensor distribution are discriminatory of most abnormalities of esophageal motility seen in clinical practice.

RESUMO Racional: A manometria de alta resolução é mais custosa, porém clinicamente superior à manometria convencional. Sistemas por perfusão de água podem ter custo diminuído, mas não é certo se são tão eficazes quanto aos sistemas de estado sólido e se os valores de referência são intercambiáveis. Objetivo: Este estudo visa validar valores de normalidade para um novo sistema por perfusão de água. Método: Valores de normalidade para um sistema de manometria de alta resolução de 24 sensores por perfusão de água foram validados estudando 225 indivíduos submetidos à manometria de alta resolução por queixas clínicas. Pacientes foram divididos em quatro grupos: grupo 1 - doença do refluxo gastroesofágico; grupo 2 - acalasia; grupo 3 - doenças sistêmicas com possível doenças sistêmicas com comprometimento esofágico; e grupo 4 - pacientes com disfagia. Resultado: No grupo 1, esfíncter esofagiano inferior hipotônico foi encontrado em 49% dos indivíduos com pHmetria positiva e 28% daqueles com pHmetria negativa. Nos grupos 2 e 3, aperistalse foi encontrada em todos indivíduos. No grupo 4, somente um paciente (14%) tinha manometria normal. Conclusão: Os valores de normalidade definidos para este sistema de manometria de alta resolução por perfusão de água são discriminatórios da maioria das anormalidades da motilidade esofágica vistas na prática clínica.

Plummer-vinson syndrome associated with lower esophageal ring (Schatzki's Ring)

We report a case of Plummer-Vinson syndrome (PVS) and lower esophageal ring with a small sliding hiatal hernia. PVS is a rare entity formed by the combination of dysphagia, cervical esophageal web and iron deficiency anemia. It occurs mainly in middle-aged women1,2,3. A lower esophageal ring and a small sliding hiatal hernia were also observed in this case. We documented clinical manifestations of iron deficiency anemia through images and esophageal abnormalities through barium esophagogram. (AU)

O papel do gradiente pressórico transdiafragmático na fisiopatologia da doença do refluxo gastroesofágico / The role of the transdiaphragmatic pressure gradient in the pathophysiology of gastroesophageal reflux disease

ABSTRACT Gastroesophageal reflux disease (GERD) is the most common disease of the upper gastrointestinal tract in the Western world. GERD pathophysiology is multifactorial. Different mechanisms may contribute to GERD including an increase in the transdiaphragmatic pressure gradient (TPG). The pathophysiology of GERD linked to TPG is not entirely understood. This review shows that TPG is an important contributor to GERD even when an intact esophagogastric barrier is present in the setting of obesity and pulmonary diseases.

RESUMO A doença do refluxo gastroesofágico (DRGE) é a enfermidade mais comum do trato digestivo alto no mundo ocidental. A fisiopatologia da DRGE é multifatorial. Diferentes mecanismos podem contribuir para um aumento do gradiente pressórico transdiafragmático (GPT). A fisiopatologia da DRGE associada ao GPT não é totalmente compreendida. Esta revisão enfoca que o GPT é um importante contribuinte para DRGE mesmo na presença de uma barreira gastroesofágica intacta como na obesidade e doenças pulmonares crônicas.

A analysis on the monitoring results of high resolution esophageal manometry and 24-Hour impedance-pH for the patients with functional heartburn and non-erosive reflux disease / 中国医学装备

Objective:To analyze the monitoring results of high resolution esophageal manometry (HRM) and 24-Hour impedance-pH for the patients with functional heartburn (FH)and non-erosive reflux disease(NERD), and explore the effect of Gastroesophageal junction morphology, transient lower esophageal sphincter relaxation and regurgitation of gastric acid in FH and NERD.Methods: 86 patients with continuous heartburn who were negative under endoscope were divided into FH group(38cases) and NERD group(48cases), and gastrointestinal symptom rating scales (GSRS), the results of HRM and 24h pH/impedance monitoring of the two groups were compared and analyzed.Results: The GSRS of sour regurgitation, abdominal distension, diarrhea and constipation of FH group were significantly higher than that of NERD group, respectively(t=-4.45,t=3.83,t=3.07,t=4.58,P<0.05). The ratio of esophagogastric junction-III(EGJ-III)of FH group was significantly lower than that of NERD group (Z=-3.27,P<0.05). And the ratio of esophageal hiatus hernia of FH group was significantly lower than that of NERD group(x2=16.01,P<0.05). In HRM parameters, the differences of lower esophageal sphincter pressure (LESP), upper esophageal sphincter pressure(UESP), distal contractile integral(DCI)and esophagogastric junction- contractile integral (EGJ-CI) between FH group and NERD group were statistically significant(t=6.99,t=-4.51,t=-2.91,t=-3.72;P<0.05), respectively. On the other hand, the times of sour regurgitation in erect position, the ratio of fluid regurgitation, exposed time of erect position and clinostatism, and DeMeester integral of NERD group was statistically significant higher than that of FH group(t=-9.48,t=-13.00,t=-13.56,t=-18.31;P<0.05).Conclusion:There are esophageal dysfunction in a certain degree and obvious regurgitation in both of two groups, and the detections of HRM and 24h-impedance pH contribute to differential diagnosis for NERG. Besides, the symptom of patients with FH may be relative with regurgitation of non-acidic material, especially may be relative with regurgitation of air.

Reflujo faringolaringeo y su relación con la ausencia de porción intra abdominal del esfínter esofágico inferior / Pharyngolaryngeal reflux and its relationship with no portion of intra abdominal lower esophageal sphincter

Objetivo: Determinar la relación entre el reflujo faríngolaríngeo y la ausencia de porción intra-abdominal del esfínter esofágico inferior. Materiales y métodos: Estudio analítico, prospectivo y de corte transversal evaluando 65 pacientes referidos a la consulta de Gastroenterología por la Consulta de Otorrinolaringología con el diagnóstico de reflujo faríngolaríngeo, del Centro Medico Docente La Trinidad en el período Enero 2013 a Noviembre 2014. Se les realizo interrogatorio evaluando síntomas típicos (regurgitación y pirosis) y síntomas atípicos (tos, carraspeo y disfonía), manometría y monitoreo del pH esofágico de 24 horas. Posteriormente se seleccionaron dos grupos a comparar: Grupo A con ausencia de porción intra-abdominal del esfínter esofágico inferior y grupo B con presencia de porción intra-abdominal del esfínter esofágico inferior. Resultados: Las variables: edad, sexo, síntomas típicos (pirosis, regurgitación), atípicos (tos, carraspeo, ronquera), presión del esfínter esofágico inferior y la motilidad del cuerpo esofágico no fueron significativas al compararse los grupos Grupo A N=17, y grupo B N=48. El monitoreo de pH esofágico de 24 horas fue estadísticamente significativo al compararse los grupos, evidenciándose que el grupo A tenía mayor porcentaje de resultados positivos para reflujos patológicos. Conclusión: La ausencia de porción intra-abdominal determinada por manometría esofágica se relaciona con la presencia de reflujos patológicos determinados por el monitoreo de pH esofágico de 24 horas, demostrando que esta puede ser un factor desencadenante de ERGE y por consiguiente de reflujo faríngolaríngeo.

Objetive: To determine the relationship between pharyngolaryngeal reflux and the absence of intra-abdominal portion of the lower esophageal sphincter. Materials and methods: Analitical, prospective study. Evaluating 65 patients referred to the consultation of the Gastroenterology from Consultation of the Otorhinolaryngology diagnosed with reflux pharyngolaryngeal of Medical Teaching Center La Trinidad period January 2013 to November 2014. They were interviewed to assess typical symptoms (heartburn and regurgitation) and atypical symptoms (cough, hawking and hoarseness), esophageal manometry and ambulatory 24 hour esophageal pH monitoring. Two groups were selected to compare: group A with no intra-abdominal portion of the lower esophageal sphincter and group B with presence of intra-abdominal portion of the sphincter upper esophageal. Results: The variables: age, gender, typical symptoms (heartburn and regurgitation) and atypical symptoms (cough, hawking and hoarseness), pressure of the lower esophageal sphinter and the motility of the esophagic body, they were not significant when compared groups. The ambulatory 24 hours esophageal pH monitoring was significant statistically when compared groups, demostrating that the group A had the highest percentage of positive results for pathological reflux. Conclusion: the absence of intra-abdominal portion determined by esophageal manometry is related to the presence of pathological reflux determined by ambulatory 24 hour esophageal pH monitoring, demonstrating that this can be a trigger factor of Gastroesophageal reflux disease and therefore pharyngolaryngeal reflux.

Acalasia como trastorno de la motilidad esofágica / Achalasia and esophageal motility disorder

La acalasia es un trastorno esofágico, de tipo motor primario y de etiología desconocida, que fue descubierta por Sir Thomas Williams en 1674. Se presenta por igual en hombres y mujeres, siendo la edad habitual de presentación entre los 25 y 60 años. Fisiopatológicamente, hay un proceso inflamatorio que conlleva a la pérdida de neurotransmisores inhibitorios y a un desbalance entre neuronas inhibitorias y excitatorias. Esto desencadena una aumentada actividad colinérgica, que ocasiona la relajación incompleta del esfínter esofágico inferior (EEI). Clínicamente, el paciente presenta disfagia, regurgitación, pirosis, halitosis, dolor torácico y disfonía. La manometría en alta resolución constituye junto con la anamnesis los métodos diagnósticos de elección, manométricamente se caracteriza por relajación insuficiente del EEI y pérdida de la peristalsis esofágica. Radiográficamente se documenta aperistalsis, dilatación esofágica con apertura mínima del EEI, apariencia en "pico de ave", así como escaso vaciamiento del bario. Endoscópicamente se visualiza dilatación esofágica con retención de saliva, líquido y partículas de alimento no digeridas en ausencia de estenosis de la mucosa o tumores. El tratamiento incluye opciones como fármacos, inyección de toxina botulínica, dilatación neumática, miotomía y esofagectomía.

Achalasia is an esophageal, primary motor disorder of unknown etiology, which was discovered by Sir Thomas Williams in 1674. It occurs equally in men and women, with the usual age of onset between 25 and 60 years. Pathophysiologically, there are an inflammatory process leading to a loss of inhibitory neurotransmitters and an imbalance between inhibitory and excitatory neurons. This triggers an increased cholinergic activity, which causes incomplete relaxation of the lower esophageal sphincter (LES). Clinically, the patient presents dysphagia, regurgitation, heartburn, dyspnea, chest pain and dysphonia. High resolution manometry constitutes together with the anamnesis, the gold standard for diagnosis. Manometry is characterized by insufficient LES relaxation and loss of esophageal peristalsis. Aperistalsis, esophageal dilation with minimal LES opening, "bird-peak" appearance, and poor emptying of barium are radiographically documented. Dilated esophagus with retention of saliva, liquid and undigested food particles in the absence of stenosis or mucosal tumors, are the main findings of the endoscopy. Treatment includes options such as drugs, botulinum toxin injection, pneumatic dilatation, myotomy, and esophagectomy.

Diet and Nutritional Management in Functional Gastrointestinal Disorder: Gastroesophageal Reflux Disease / 대한내과학회지

Gastroesophageal reflux disease (GERD) is a common condition with a wide range of clinical manifestations. The clinical epidemiology of GERD is related to diet. It has been speculated that certain dietary factors may play a role in the pathogenesis or course of GERD. Physiological studies have shown a decrease in lower esophageal pressure and an increase in esophageal acid exposure in response to consuming a variety of foods. Subjects with GERD are sensitive to acidic juices, such as orange and tomato juices. Some patients are less tolerant to caffeine including coffee. Fatty foods and chocolate may weaken the lower esophageal sphincter, whereas protein may increase lower sphincter tone. Large meals distend the stomach, increase intragastric pressure, and facilitate gastroesophageal reflux. Alcohol consumption is another important risk factor for GERD. However, a wide-ranging review of the available data revealed conflicting findings regarding the impact of dietary factors on GERD.

LOWER ESOPHAGEAL SPHINCTER PRESSURE MEASUREMENT UNDER STANDARDIZED INSPIRATORY MANEUVEURS / MEDIDAS DAS PRESSÕES DO ESFÍNCTER ESOFÁGICO INFERIOR POR MANOBRAS INSPIRATÓRIAS PADRONIZADAS

Background:Through rhythmic variations, the diaphragm influence lower esophageal sphincter (LES) pressure acting as an external sphincter. LES pressure recording is characterized by increased pressure in inspiration due to contraction of the diaphragmatic crura that involves the sphincter.Aim:To describe a method of measuring LES pressure during standardized inspiratory maneuvers with increasing loads.Methods:The study population comprised of eight healthy female volunteers (average age of 31.5 years). An esophageal high-resolution manometry and impedance system was used for measuring the LES pressure during 3-second inspiratory efforts under 12, 24 and 48 cm H2O loads (Threshold maneuvers).Results:There was a significant difference between the average maximum LES pressure and the average maximum basal LES pressure during the first (76.19±17.92 difference, p=0.0008), second (86.92±19.01 difference, p=0.0004), and third seconds of the maneuver (90.86±17.93 difference, p=0.0002), with 12, 24 and 48 cmH2O loads.Conclusion:This maneuver is a standardization of the inspiratory LES pressure and may better differentiate patients with reflux disease from healthy individuals, and may also be useful for monitoring the treatment of these patients through inspiratory muscle training.

Racional:Através de variações rítmicas, o diafragma influencia a pressão do EEI, atuando como um esfíncter externo. O registro manométrico da sua pressão caracteriza-se por aumento de pressão na inspiração resultante da contração da crura diafragmática que envolve o esfíncter. Objetivo:Descrever um método de medida da pressão do esfíncter esofágico inferior (EEI) durante manobras inspiratórias padronizadas, com cargas crescentes.Métodos:Oito voluntários sadios (sexo feminino, média de idade de 31,5 anos) participaram do estudo. Uma manometria esofágica de alta resolução e impedanciometria mediram a pressão do EEI durante manobras inspiratórias com o Threshold sob cargas de 12, 24 e 48 cm H2O. Resultados:Comparando-se as médias houve diferença significativa entre a pressão máxima do EEI e a sua pressão basal máxima durante o primeiro (diferença de 76,19±17,92, p=0,0008), segundo (diferença 86,92±19,01, p=0,0004) e terceiro segundos da manobra (diferença 90,86±17,93, p=0,0002), tanto com carga de 12 cm de H2O, quanto com 24 e 48 cm. Conclusão:Esta manobra é uma padronização da pressão inspiratória do EEI e pode diferenciar melhor pacientes com doença do refluxo de indivíduos sadios, podendo também ser útil na monitorização do tratamento desses pacientes por meio do treinamento muscular inspiratório.

Reconsideration of Gastroesophago-larygotracheal Syndrome and Progress of Endoscopic Radiofrequency Energy Delivery for Gastroesophageal Reflux Disease / 中国微创外科杂志

[Summary] As the gradual deepening understanding of gastroesophageal reflux disease ( GERD ) , more extraesophageal symptoms are noted .The concept and therapeutic strategy for GERD has also undergone a quiet revolution over recent years .The application of proton pump inhibitor ( PPI) has been a landmark of medical treatment for GERD , and the invention of laparoscopic fundoplication and endoscopic radiofrequency energy delivery to the lower esophageal sphincter are marking a new era of comprehensive therapy for GERD .Good short and long term outcomes have been obtained since endoscopic radiofrequency energy delivery to the lower esophageal sphincter was applied on typical symptoms of GERD .Furthermore, the technique has also been successfully used in treating extraesophageal symptoms induced by proximal reflux in China .With more simple and less invasive features compared with anti-reflux surgery, the radiofrequency procedure has broad application prospects .

Balloon dilatation of Forley catheter in establishing a reflux esophagitis model / 第二军医大学学报

Objective To explore a safe and effective way to establish reflux esophagitis model consistent with the anatomical structure. Methods Forty-five New Zealand rabbits aged 5 months were randomly divided into three groups. The rabbits undergoing lower esophageal sphincter incision were assigned to A group, those undergoing partial cardiomyectomy to B group, and those undergoing balloon dilatation by Forley catheter to C group. All the rabbits underwent esophageal fistulation before establishment of reflux esophagitis model. 24 hour-pH monitoring was performed to all the rabbits before and at 2 weeks postoperatively. At 4 weeks postoperatively, the animals were sacrificed for histological and electron microscopic results. Results The mortality rate in B group was higher than those of the other 2 groups (P=0.057). With respect to the total time ratio of pH 5 min, a clear trend was seen as B group > C group > A group; however, there were no significant differences among the 3 groups. The success rates of establishing reflux esophagitis model were similar among the 3 groups. For the reflux esophagitis models, moderate/severe esophagitis was more commonly-seen in B group than in the other 2 groups, but showing no significant difference. Conclusion Partial cardiomyectomy is a more effective way to establish a reflux esophagitis model, but with higher mortality. Balloon dilatation is a safe and effective to establish a reflux esophagitis model, which is also more consistent with anatomical structure and suitable for research of endoscopic or other new surgeries.

Study on Pathology and Neurotransmitters of Esophageal Sphincter after Radiofrequency Thermocoagulation in Dogs / 天津医药

Objective To investigate the effects of radiofrequency thermocoagulation (RFT) on pathological features and the expressions of choline acetyltransferase (ChAT), vasoactive intestinal peptide (VIP) and nitric oxide synthase (NOS) at lower esophageal sphincter (LES) in family dogs. Methods A total of 15 dogs were randomly divided into three groups. Sham group underwent gastroscopy and was fed for 3 months (n=5). Dogs were given RFT and were fed for 24 h after RFT (n=5, RFT+24 h group). Dogs were given RFT and were fed for 3 months after RFT (n=5, RFT+3m group). The pathological changes of LES were observed after HE staining in three groups. The expressions of ChAT, VIP and NOS were detected by immunohistochemical method in three groups. Results Results of HE staining showed nearly the same tissues in Sham group and control group. There were active inflammatory reaction and structural damage in RFT+24 h group. The chronic in-flammatory reaction and structural remodeling were found in RFT+3m group. Immunohistochemistry showed that ChAT was significantly increased in RFT+3m group compare than that of Sham group. Values of VIP and NOS were significantly de-creased in RFT+3m group compare than that of Sham group (P<0.01). Conclusion The thickness and increased pressure of LES were found after RFT,which also caused changes in neurotransmitters of local tissues in dogs.

Incidence and morphology of Laimer fiber in achalasia patients / 中华消化内镜杂志

Objective To investigate the incidence,location and morphological features of Laimer fibers between mucosal layer and inner circular muscularispropria in patients with achalasia.Methods Data of 107 patients with achalasia who underwent POEM between May 2010 and June 2013 were collected.Endoscopic video was reviewed to determine the incidence of Laimer fibers and the corresponding images were analyzed according to gender,age,Ling typing and location of Laimer fibers.Results Laimer fibers were found in lower esophageal sphincter of 44 patients (41.12％).There were no significant differences in the incidences of Laimer fiber among groups with different age or gender (P ＞ 0.05).The incidence in Ling type Ⅱb was 46.15％ (12/26),and 45.83％ (22/48) in Ling type Ⅰ,0 in Ling type Ⅲ.There was no significant difference among the groups of Ling type (x2 =2.042,P =0.564).All Laimer fibers were found in lower esophageal sphincter and the majority of which were in right wall (36.45 ％,39/107),followed by left wall (3.74％,4/107) and none was found in anterior wall (x2 =107.468,P =0.000).Conclusion Laimer fibers generally exists in lower esophageal sphincter and most of which are discovered on right wall of the esophagus.Further study is needed to explore its role in development and treatment of achalasia.

Effects of Acupuncture Therapy with Finger on Back-shu Point on Acid Reflux and Lower Esophageal Sphincter Pressure of GERD Patients / 中国中医药信息杂志

Objective To observe the effects of acupuncture therapy with finger on back-shu point on acid reflux and lower esophageal sphincter pressure (LESP) of the patients with gastroesophageal reflux disease (GERD). Methods Totally 120 patients of GERD were randomly divided into treatment group and control group through random number table method, 60 cases in each group. Patients in the treatment group were treated with the acupuncture therapy with finger on back-shu point, and patients in control group were treated with lansoprazole tablets and dispersible mosapride citrate for two weeks. Total percentage of acid reflux time, the long time acid reflux episodes, and the longest acid reflux time of two groups were observed six months after the treatment. At the same time, the LESP variation of two groups was followed up six months after the treatment. Results The total percentage of acid reflux time, the long time acid reflux episodes, and the longest acid reflux time decreased significantly in all patients after treatment (P0.05). After treatment, LESP of two groups was significantly improved (P0.05). Conclusion The acupuncture therapy with finger on back-shu point can reduce acid reflux, and achieve the goal of treatment of GERD by improving the lower esophageal sphincter pressure. The duration of improving LESP is longer.

Regulation of L-type Calcium Channels by Xuanfu Daizhe Soup in the Lower Esophageal Sphincter Smooth Muscle of Rabbit Reflux Esophagitis Model / 浙江中医药大学学报

Objective]To research the regulation of L-type calcium channels by Xuanfu Daizhe soup in the lower esophageal sphincter(LES) smooth muscle of rabbit reflux esophagitis model induced by mixed perfusion of hydrochloric acid and bile. [Methods]Established the rabbit model of mixed reflux esophagitis, nifedipine was used to block L-type calcium channel.The muscle tension of L-type calcium channel were compared among groups in the experiments. [Results]The calcium releasing and flowing phase of LES in the model group was higher than that in the normal group, the whole recipe group, sweet-scending group, the getting rid of bitter-reducing group and the getting rid of lifting and declining group( P0.05). There was no significant difference between the normal group and the whole recipe group in calcium releasing and flowing phase of LES( P>0.05). [Conclusion]The decreasing of reflux esophagitis model LES tension was relevant with the L-type calcium channel dysfunction;Xuanfu Daizhe soup could improve the LES tension by regulating L-type calcium channels. The sweet-ascending group had a remarkable effect among those dismantle prescription groups.

Belching (Eructation) / 대한소화기학회지

Belching is a normal physiological function that may occur when ingested air accumulated in the stomach is expelled or when food containing air and gas produced in the gastrointestinal tract is expelled. Excessive belching can cause patients to complain of abdominal discomfort, disturbed daily life activities, decreased quality of life and may be related to various gastrointestinal disorders such as gastroesophageal reflux disease, functional dyspepsia, aerophagia and rumination syndrome. Belching disorders can be classified into aerophagia and unspecified belching disorder according to the Rome III criteria. Since the introduction of multichannel intraluminal impedance monitoring, efforts are being made to elucidate the types and pathogenic mechanisms of belching disorders. Treatment modalities such as behavioral therapy, speech therapy, baclofen, tranquilizers and proton pump inhibitors can be attempted, but further investigations on the effective treatment of belching disorders are warranted.

Pathogenesis of Achalasia

Achalasia is a rare esophageal motilty disorder characterized by loss of myenteric neurons leading to aperistalsis of the esophageal body and impaired relaxation of the lower esophageal sphincter (LES). Esophageal peristalsis and relaxation of the LES are mediated by myenteric neurons. Achalasia may be an autoimmune disease targeting esophageal myenteric neurons with cell-mediated and antibody-mediated attack to an unidentified antigen. It is still unknown how these immunologic attacks begin and why these are functionally limited to the esophagus. Initial immunologic reactions can begin in genetically predisposed persons who had viral infection, such as herpes simplex virus 1. The type of immune response and the intensity of the cytotoxic T-cell attack can determine the clinical presentation of the disease. Patients with Chicago Classification type III achalasia may present with chronic inflammation in the absence of neuronal loss, where as patients with Chicago Classification type I or II achalasia present with a predominantly cytotoxic immune response with progressive loss of myenteric neurons. Further well controlled researches which reveal the unknown facts of pathogenesis are needed.

Related factors of gastroesophageal reflux disease / 中国基层医药

Objective To investigate the related risk factors of gastroesophageal reflux disease (GERD).Methods 1 200 patients were chosen,including 99 GERD patients in the observation group,another 99 patients with non-GERD in control group.Questionnaires and esophageal and gastric pressure measurement method were used to analyze the related risk factors of GERD.LESP LESL,GP,the LESP-GP and LESP/GP's were compared between the observation group and the control group.Results In 1 200 patients participating in the survey,99 patients were confirmed GERD,with a ratio of 8.25％.Multivariate logistic regression analysis showed that eating too full,to eat before going to bed,like greasy food,spicy foods,heavy drinking and smoking were important factors affecting the incidence of GERD.2 LESL,LESP/GP and LESP-GP of the observation group were significantly less or lower than those of the control group,GP was significantly higher than that of the control group,the differences were statistically significant (t =12.216,12.515,8.973,3.437,all P ＜0.05).Conclusion Poor eating habits and lifestyle are important risk factors for GERD,the lower esophageal sphincter dysfunction and intragastric pressure increases in GERD incidence occupies an important position,should take positive interventions.