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

Y. Y. Lee, J. G. H. Whiting, M. H. Derakhshan, A. A. Wirz, D. Smith, D. Morrison, A. Kelman, P. Connolly, K. E. L. McColl, Patricia Connolly

Research output: Contribution to journalArticle

22 Citations (Scopus)

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. 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 (1.68.8 cm) and this was substantially greater than during swallowing at 1.2 cm (0.42.7 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.

LanguageEnglish
Pages990-999
Number of pages10
JournalNeurogastroenterology and Motility
Volume24
Issue number11
DOIs
Publication statusPublished - Nov 2012

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Swallows
Lower Esophageal Sphincter
Hiatal Hernia
Healthy Volunteers
Deglutition
Ligaments
Magnets
Diaphragm
Meals
Leg

Keywords

  • gastro-esophageal junction
  • Hall effect
  • hiatus hernia
  • phreno-esophageal ligament
  • swallows
  • transient lower esophageal sphincter relaxation

Cite this

Lee, Y. Y. ; Whiting, J. G. H. ; Derakhshan, M. H. ; Wirz, A. A. ; Smith, D. ; Morrison, D. ; Kelman, A. ; Connolly, P. ; McColl, K. E. L. ; Connolly, Patricia. / Kinetics of transient hiatus hernia during transient lower esophageal sphincter relaxations and swallows in healthy subjects. In: Neurogastroenterology and Motility. 2012 ; Vol. 24, No. 11. pp. 990-999.
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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. 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 (1.68.8 cm) and this was substantially greater than during swallowing at 1.2 cm (0.42.7 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.",
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Lee, YY, Whiting, JGH, Derakhshan, MH, Wirz, AA, Smith, D, Morrison, D, Kelman, A, Connolly, P, McColl, KEL & Connolly, P 2012, 'Kinetics of transient hiatus hernia during transient lower esophageal sphincter relaxations and swallows in healthy subjects' Neurogastroenterology and Motility, vol. 24, no. 11, pp. 990-999. https://doi.org/10.1111/j.1365-2982.2012.01948.x

Kinetics of transient hiatus hernia during transient lower esophageal sphincter relaxations and swallows in healthy subjects. / Lee, Y. Y.; Whiting, J. G. H.; Derakhshan, M. H.; Wirz, A. A.; Smith, D.; Morrison, D.; Kelman, A.; Connolly, P.; McColl, K. E. L.; Connolly, Patricia.

In: Neurogastroenterology and Motility, Vol. 24, No. 11, 11.2012, p. 990-999.

Research output: Contribution to journalArticle

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T1 - Kinetics of transient hiatus hernia during transient lower esophageal sphincter relaxations and swallows in healthy subjects

AU - Lee, Y. Y.

AU - Whiting, J. G. H.

AU - Derakhshan, M. H.

AU - Wirz, A. A.

AU - Smith, D.

AU - Morrison, D.

AU - Kelman, A.

AU - Connolly, P.

AU - McColl, K. E. L.

AU - Connolly, Patricia

PY - 2012/11

Y1 - 2012/11

N2 - 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 (1.68.8 cm) and this was substantially greater than during swallowing at 1.2 cm (0.42.7 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.

AB - 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 (1.68.8 cm) and this was substantially greater than during swallowing at 1.2 cm (0.42.7 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.

KW - gastro-esophageal junction

KW - Hall effect

KW - hiatus hernia

KW - phreno-esophageal ligament

KW - swallows

KW - transient lower esophageal sphincter relaxation

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U2 - 10.1111/j.1365-2982.2012.01948.x

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