Architecture and function of the gastroesophageal barrier in the piglet.

We describe the anatomy and function of the gastroesophageal barrier in the piglet. Male piglets underwent dissection (N = 6) and gastroesophageal muscle layer histometry (N = 6). Sedated, nonintubated animals (N = 13) underwent four-probe perfusion esophageal manometry and the pressure profiles were related to the muscular thickness in the four quadrants. Hiatal and gastroesophageal anatomy are similar to our own. The muscle is thicker at the point where the clasp (on the right side) and sling fibers (on the left) concentrate. The pressure profiles were axially and radially asymmetric in coincidence with the thickness variations of the corresponding muscle layers. Sphincteric pressure was recorded as a plateau, whereas diaphragmatic crural pressure appeared as phasic oscillations in synchrony with respiration. The sphincter relaxed upon deglutition. In conclusion, the gastroesophageal structure and physiology are so similar in men and piglets that piglets are excellent models for research in this area.

Acute food bolus impaction without stricture in children with gastroesophageal reflux.

BACKGROUND/PURPOSE: This report identifies a group of children in whom severe acute food bolus impaction (AFBI) was the leading symptom of gastroesophageal reflux (GER) in the absence of stricture. METHODS: The esophageal structure and function of 8 patients treated for AFBI requiring endoscopic removal of alimentary foreign bodies in 6 of them (up to 4 times in 1 case) were investigated by barium meal, esophagoscopy-biopsy, pH-metering, pull-through stationary manometry, and 24-hour ambulatory manometry. The results were compared with those in a group of age-matched regular refluxers (n = 14) without AFBI. RESULTS: Six boys and 2 girls aged 108 +/- 59 months had impaction. Six children had symptoms of GER like vomiting during infancy, heartburn, or respiratory tract disease. Barium swallow ruled out stenosis in all patients and showed small hiatal hernias in 3. All had endoscopic and histologic esophagitis (moderate to severe in 6), and one had Schatzki ring. All but one (who had 8.45 mm Hg) had normal lower esophageal sphincter pressure (16.2 +/- 4.7 mm Hg, mean +/- SD), and all showed normal sphincteric relaxation. Esophageal body motility was not significantly different from that in regular refluxers except in 6 children in whom energetic distal peristalsis after reflux episodes could be seen particularly during the night. Three of them had amazingly powerful distal waves during the day and even stronger, simultaneous, wide and bizarre-shaped waves during sleep. Symptoms improved in all cases after antireflux medication. Four patients were cured after antireflux surgery. CONCLUSIONS: AFBI is a dramatic but practically unheard of symptom of GER in children. It should be differentiated from dysphagia and reveals motor dysfunction, sometimes severe, of the esophageal body in the absence of sphincteric obstruction. Antireflux medication or surgery were uniformly successful in our patients.