Research Progress on Relationship Between Gastroesophageal Flap Valve and Gastroesophageal Reflux Disease / 中国微创外科杂志

[Summary] The mechanisms of gastroesophageal reflux disease ( GERD) include abnormal antireflux function and esophageal mucosa attacked by regurgitation .Gastroesophageal flap valve ( GEFV) located in the gastroesophageal junction is one mechanism of the antireflux barrier .An increased GEFV grade is associated with an increased incidence of erosive esophagitis and Barrett ’ s epithelium.With abnormal esophageal acid exposure and prevalence of a mechanically defective sphincter , patients usually have severe symptoms and lower efficiency of medication .Therefore , GEFV is valued in the diagnosis and treatment of GERD .This review summarized the relationship between GEFV and GERD .

Endoscopic observations around the gastroesophageal junction in patients with symptomatic gastroesophageal reflux disease in South Asia.

Introduction We studied the inter-relationships of endoscopic findings around the gastroesophageal junction in patients with symptomatic gastroesophageal reflux. Methods Data were collected with regard to hiatus hernia (HH), columnar-lined esophagus (CLE), reflux esophagitis (RE) and gastroesophageal flap valve (GEFV), prospectively from 1,150 patients who underwent diagnostic upper gastrointestinal endoscopy for symptomatic gastroesophageal reflux. Results The frequency of HH, CLE and RE was 14.3% (n=165), 9.5% (n=109) and 13.3% (n=153), respectively. In the CLE group, 48 were histologically proven to have Barrett’s esophagus. Of all RE patients, 94.8% had mild esophagitis (LA-A and B) and this was associated with younger age, male gender, presence of HH, and grade 3 or 4 gastroesophageal flap valve (GEFV). Grades 3 and 4 GEFV were associated with HH, CLE, and RE. Conclusions Substantial proportion of patients with symptoms of GERD has abnormal endoscopic findings around the gastroesophageal junction.

Relationship between gastroesophageal flap valve and reflux esophagitis / 中华消化内镜杂志

Objective To investigate the relationship between gastroesophageal flap valve (GEFV) and reflux esophagitis(RE).Methods We analyzed 239 cases of RE diagnosed by endoscopy in our hospital from January 2007 to December 2009.RE was classified by Los Angeles classification system and GEFV by Hill system.The association of GEFV with RE was analyzed.Results The overall incidence of abnormal GEFV was32.9% (316/960) and that of RE was 24.9% (239/960).The incidence of severe RE ( grade C and D) in abnormal GEFV group was significantly higher than that in normal GEFV group (23.1% vs.2.4% , P = 0.000).RE grades were positively correlated with GEFV grades (r = 0.308, P = 0.000 ).The incidence of abnormal GEFV in RE patients was higher than that in non-RE (65.3% vs.22.2% ,P = 0.00 ).In terms of gender, there were more males than females in both RE group (63.6% vs.36.4% ) and abnormal GEFV group (60.1% vs.39.9% ).Additionally, incidence of RE increased with age, i.e.positively correlated with age (r=0.214,P =0.000).The incidence of abnormal GEFV also increased significantly in those over 30 years old, i.e.positively correlated ( r = 0.129, P = 0.000).Conclusion There is correlation between GEFV abnormality and RE.GEFV provides useful information for assessment and prediction of the reflux status of the patients.

Endoscopic findings around the gastroesophageal junction: an experience from a tertiary hospital in Korea

BACKGROUND/AIMS: Important lesions related to gastroesophageal reflux disease (GERD) are located around the gastroesophageal junction (GEJ). This study examined the distribution of endoscopic findings around the GEJ and elucidated their relationship to each other and esophageal manometric features. METHODS: Endoscopic data were collected prospectively from 2,450 consecutive diagnostic upper gastrointestinal endoscopies. The presence and degree of hiatal hernia (HH), columnar-lined esophagus (CLE), and reflux esophagitis (RE) were recorded. Esophageal manometric data were collected from 181 patients. RESULTS: The prevalence of HH, CLE, and RE was 9.8, 18.8, and 9.9%, respectively. Of all HH and CLE cases, 62.8 and 98.9%, respectively, were of the short-segment variety. Of all RE cases, 95.0% were mild. Younger age, male gender, the presence of HH, and a higher gastroesophageal flap valve (GEFV) grades were associated with the presence of RE. Increased ZAP grades were associated with increased prevalence and grades of HH, CLE, and RE. Higher GEFV grades were associated with increased prevalence and grades of HH, CLE, and RE. Lower esophageal sphincter pressure (LESP) decreased in patients with HH or RE compared to those without HH or RE. CONCLUSIONS: Endoscopic findings around the GEJ revealed that a substantial proportion of our patients showed features potentially related to GERD. In combination with other recent reports, our study implies that Korea is no longer a very-low-prevalence area of GERD, although it may predominate in silent or milder forms.

Association between Gastroesophageal Flap Valve and Gastroesophageal Reflux / 대한소화기내시경학회지

BACKGROUND/AIMS: Endoscopic grading of the gastroesophageal flap valve (GEFV) was suggested to be a good predictor of the gastroesophageal reflux status. The aim of this study was to examine the association between the GEFV and gastroesophageal reflux. METHODS: A total of 599 patients (245 men and 354 women; mean age 51.0 +/- 0.5 years) who underwent endoscopy, esophageal manometry, and ambulatory pH monitoring were included. GEFV was graded I through to IV using Hill's classification. The GEFV was classified into main 2 groups: the normal GEFV (grade I and II) and the abnormal GEFV groups (grade III and IV). The findings of endoscopy, esophageal manometry, and ambulatory pH monitoring were compared. RESULTS: An increased GEFV grade was significantly associated with reflux esophagitis and Barrett's epithelium (p < 0.001). The LES pressure was significantly lower in the abnormal GEFV group (p < 0.001). All variables showing gastroesophageal reflux in the probe were significantly higher in the abnormal GEFV group (p < 0.001). The frequency of gastroesophageal reflux disease (GERD) was higher in the abnormal GEFV group (p < 0.001). CONSLUSIONS: There is an association between the altered geometry of the GEFV and the presence of GERD. The endoscopic grading of the GEFV is easy and provides useful information on the gastroesophageal reflux status.