Characterization of the distal esophagus high-pressure zone with manometry, ultrasound and micro-computed tomography.
Characterization of the distal esophagus high-pressure zone with manometry, ultrasound and micro-computed tomography.
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DOI：
10.1111/nmo.12010
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发表时间：
2013-01
影响因子：
3.5
通讯作者：
Miller LS
中科院分区：
文献类型：
--
作者：
Vegesna AK;Sloan JA;Singh B;Phillips SJ;Braverman AS;Barbe MF;Ruggieri MR Sr;Miller LS
我们试图确定食管远端和近端胃的各个组成部分如何形成胃食管交界处高压区（GEJHPZ）抗反流屏障。在20名正常受试者中，通过胃近端和食管远端牵引内镜超声/测压导管。测量了超声内镜下单个结构的轴向长度和宽度。采用显微计算机断层扫描（micro-CT）对两个器官供体标本进行了胃食管交界处（GEJ）成分的解剖取向检测。从远端到近端，在GEJHPZ中发现了三个不同的结构，分别是：胃扣和背肌纤维复合体、脚膈肌和食管下环平滑肌纤维（LEC）。LEC较邻近食管肌厚，差异有统计学意义。这些结构与3个压力峰有关。由卡环/悬索纤维复合体产生的压力峰值经常与来自脚膈的压力峰值重叠。与LEC相关的最近端峰值在20名受试者中有9名明显更大且呈双峰。双峰LEC压力峰值与超声观察到的两个增厚肌肉区域相关。来自器官供者的GEJ微ct证实了两个增厚的肌肉区域。三种不同的解剖结构，扣环和悬索肌纤维，脚膈肌和LEC结合在一起形成胃近端和食管远端的抗反流屏障。卡环和吊索肌纤维与脚膈肌结合形成远端压力剖面。在一些患者中，更近端的LEC具有双峰压力分布。
We sought to determine how the individual components of the distal esophagus and proximal stomach form the gastroesophageal junction high-pressure zone (GEJHPZ) anti-reflux barrier. An endoscopic ultrasound/manometry catheter was pulled through the proximal stomach and distal esophagus in 20 normal subjects. The axial length and width of individual structures on endoscopic ultrasound were measured. The anatomic orientation of gastroesophageal junction (GEJ) components was examined in two organ donor specimens using micro-computed tomography (micro-CT). The three distinct structures identified within the GEJHPZ, from distal to proximal, were: the gastric clasp and sling muscle fiber complex, crural diaphragm, and lower esophageal circular smooth muscle fibers (LEC). The LEC was statistically significantly thicker than adjacent esophageal muscles. These structures were associated with 3 pressure peaks. The pressure peak produced by the clasp/sling fiber complex often overlapped with the pressure peak from the crural diaphragm. The most proximal peak, associated with the LEC, was significantly greater and bimodal in 9 of 20 subjects. This bimodal LEC pressure peak correlated with two areas of thickened muscle observed with ultrasound. Micro-CT of GEJ from organ donors confirmed the two areas of thickened muscle. Three distinct anatomic structures, the clasp and sling muscle fibers, crural diaphragm, and LEC combine to form the anti-reflux barrier of the proximal stomach and distal esophagus. The clasp and sling muscle fibers combine with the crural diaphragm to form a distal pressure profile. The more proximal LEC has a bimodal pressure profile in some patients.
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影响因子：
3.7
作者：
Kahrilas, PJ
通讯作者：
Kahrilas, PJ
DOI：
10.1111/j.1440-1746.2003.03307.x
发表时间：
2004-04-01
影响因子：
4.1
作者：
Tian, ZQ;Liu, JF;Zhang, YF
通讯作者：
Zhang, YF
影响因子：
24.5
作者：
Mittal, RK;Chiareli, C;Dixon, S
通讯作者：
Dixon, S
影响因子：
5.5
作者：
Brasseur, James G.;Ulerich, Rhys;Miller, Larry S.
通讯作者：
Miller, Larry S.
DOI：
10.1152/ajpgi.00534.2003
发表时间：
2004-07-01
影响因子：
4.5
作者：
González, AA;Farré, R;Clavé, P
通讯作者：
Clavé, P