Clinical-alimentary tractEsophagogastric junction opening during relaxation distinguishes nonhernia reflux patients, hernia patients, and normal subjects☆
Section snippets
Subjects
Seven NL (4 males, 23–33 years old) without reflux symptoms, 7 patients with GERD and HH (5 males, 28–53 years old), and 9 GERD patients without HH (NHH) (5 males, 24–48 years old) were studied. The patients were enrolled from the gastrointestinal diagnostic laboratory at Northwestern Memorial Hospital. Patients were classified as HH or NHH based on recent upper endoscopy results (performed by P.J.K. or J.E.P.). The endoscopic criterion for HH was that the position of the squamocolumnar
Manometric measures of EGJ function
Manometric data for each group are shown in Table 2. Using ANOVA, no significant difference existed in mean basal LES pressure among the 3 groups. However, an unpaired t test revealed a significant difference in LES pressure between NL and HH patients (P < 0.005). Neither ANOVA nor an unpaired t test revealed any significant differences in LES relaxation pressure or intragastric pressure among the 3 subject groups.
EGJ opening during low-pressure distention
The smallest EGJ opening aperture during deglutitive relaxation occurred at the
Discussion
The central hypothesis leading to this report was that mechanical alterations of the EGJ might underlie differences in both the volume and the constituents of reflux in GERD patients with or without hiatus hernia. The major findings of the paper were that (1), at distention pressures greater than intragastric pressure, the relaxed EGJ opened incrementally wider in HH patients compared with NHH patients and in NHH patients compared with NL subjects, and (2) at distention pressures greater than
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Supported by grants RO1 DC00646 (to P.J.K.) from the Public Health Service and K23 DK62170-01 (to J.E.P.).