Pathophysiology of Gastroesophageal Reflux
The gastroesophageal junction is an area of great anatomical and functional complexity whose role is to restrict physiological gastroesophageal reflux (GER) (Fig. 1). “Restricting” is the operative word inasmuch as reflux is, within certain limits, a totally physiological phenomenon. In fact, GER is assisted by the gradient between the positive pressure of the stomach (10–20 mm Hg) and the pressure of the esophagus which, as a result of intrapleural pressure, is almost always negative (ranging from 0 to −10 mm Hg). Furthermore, certain movements (e.g. inspiring, bending forward, straining, coughing) cause a marked increase in abdominal pressure. For this reason food present in the stomach would constantly rise back up into the esophagus were it not for the intervention of competence mechanisms — competence being defined as the ability to restrict and contain the incidence of gastroesophageal refluxes.
KeywordsHiatal Hernia Gastroesophageal Reflux Lower Esophageal Sphincter Gastroesophageal Junction Lower Esophageal Sphincter Pressure
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