Kinetics of transient hiatus hernia during transient lower esophageal sphincter relaxations and swallows in healthy subjects

Lee, Y.Y., Whiting, J.G.H., Robertson, E.V., Derakshan, M.H., Wirz, A.A., Smith, D., Morrison, D.J. , Kelman, A.W. and McColl, K.E.L. (2012) Kinetics of transient hiatus hernia during transient lower esophageal sphincter relaxations and swallows in healthy subjects. Neurogastroenterology and Motility, 24(11), pp. 990-998. (doi: 10.1111/j.1365-2982.2012.01948.x)

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Abstract

Background: Proximal displacement of the gastro-esophageal junction (GEJ) is present in hiatus hernia but also occurs transiently during transient lower esophageal sphincter relaxations (TLESRs) and swallows. Using a novel magnetic-based technique we have performed detailed examination of the GEJ movement during TLESRs and swallows in healthy subjects. <p/>Methods: In 12 subjects, a magnet was endoscopically clipped to the GEJ and combined assembly of Hall-Effect locator probe and 36 channel high-resolution manometer passed nasally. After a test meal the subjects were studied for 90 min. <p/>Key Results: The median amplitude of proximal movement of GEJ during TLESRs was 4.3 cm (1.6–8.8 cm) and this was substantially greater than during swallowing at 1.2 cm (0.4–2.7 cm), P = 0.002. With both TLESRs and swallows proximal GEJ movement coincided with lower esophageal sphincter (LES) relaxation and return to its original position occurred 4 s after return of LES tone. Kinetic modeling of the movement of the GEJ during TLESRs indicated two return phases with the initial return phase having the greater velocity (0.9 cm s−1) and being strongly correlated with amplitude of proximal movement (r = 0.8, P < 0.001). <p/>Conclusions and Inferences: The marked proximal GEJ migration during TLESRs represents very severe herniation of the GEJ. The rapid initial return of the GEJ following TLESRs when the crural diaphragm is relaxed and its correlation with amplitude suggest it is due to elastic recoil of the phreno-esophageal ligament. The marked stretching of the phreno-esophageal ligament during TLESRs may contribute to its weakening and development of established hiatus hernia.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Morrison, Dr Douglas and Lee, Dr Yeong and McColl, Professor Kenneth and Robertson, Dr Elaine
Authors: Lee, Y.Y., Whiting, J.G.H., Robertson, E.V., Derakshan, M.H., Wirz, A.A., Smith, D., Morrison, D.J., Kelman, A.W., and McColl, K.E.L.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Science and Engineering > Scottish Universities Environmental Research Centre
Journal Name:Neurogastroenterology and Motility
ISSN:1350-1925
Published Online:11 June 2012

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