Examination of the Hiatal Defence Mechanism with Manometry Including an Abdominal Pressure Test. A Comparative Study with 24-Hour pH Monitoring and Esophagoscopy
A normally efficient clamping mechanism between the stomach and the esophagus prevents backflow of gastric contents into the esophagus. There is a widespread conception that the lower esophageal sphincter (LES) constitutes the most important protection against reflux, irrespective of whether the location of the sphincter is in the hiatal channel or, as in the case of a sliding hernia, in the thoracic cavity [1–2]. However, there is also conflicting evidence, and some authors have stressed the importance of the hiatal mechanism in preventing reflux [3–9]. On contraction of the diaphragm, the muscles around the hiatus also contract, thereby pinching the esophagogastric tract which passes through the hiatus. One can also consider the hiatus simply as a gap. When there is an increased pressure difference across the diaphragm, the stomach wall and/or other viscera are forced towards and into the hiatal channel. Herniation may occur, and thereby the hiatal channel can be plugged, thus constricting the lumen of the esophagogastric tract.
KeywordsLower Esophageal Sphincter Hiatus Level Reflux Time Abdominal Compression Rubber Bladder
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