Kinetics of transient hiatus hernia during transient lower esophageal sphincter relaxations and swallows in healthy subjects
Version of Record online: 11 JUN 2012
© 2012 Blackwell Publishing Ltd
Neurogastroenterology & Motility
Volume 24, Issue 11, pages 990–e539, November 2012
How to Cite
Lee, Y. Y., Whiting, J. G. H., Robertson, E. V., Derakhshan, M. H., Wirz, A. A., Smith, D., Morrison, D., Kelman, A., Connolly, P. and McColl, K. E. L. (2012), Kinetics of transient hiatus hernia during transient lower esophageal sphincter relaxations and swallows in healthy subjects. Neurogastroenterology & Motility, 24: 990–e539. doi: 10.1111/j.1365-2982.2012.01948.x
- Issue online: 11 OCT 2012
- Version of Record online: 11 JUN 2012
- Received: 19 March 2012 Accepted for publication: 8 May 2012
- gastro-esophageal junction;
- Hall effect;
- hiatus hernia;
- phreno-esophageal ligament;
- transient lower esophageal sphincter relaxation
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.
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.
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).
Conclusions & 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.