Abstract

Conventional methods of radiographic examination in gastroesophageal reflux disease (GERD) are not used due to low reliability. A new method of radiographic examination of the esophagus is described in 7 patients with GERD, in whom, unlike 79 examined patients, examined by the same method a physiological sphincter was found at the level of the aortic arch, which was responsible for the occurrence of non-esophageal symptoms. We call it aorto-esophageal sphincter (AES). It has been shown that in healthy individuals, two anatomical sphincters (upper esophageal sphincter and lower esophageal sphincter - LES) ensure normal functioning of the esophagus. LES prevents reflux of aggressive gastric contents into the esophagus. The crural diaphragm contracts briefly during deep inspiration and increased gastric pressure, which enhances the antireflux function of the LES. The LES does not move into the chest. In patients with GERD, the esophagus expands, and its peristalsis weakens. For the last peristaltic wave to be able to create a pressure in the dilated esophagus that can open the LES and is greater in magnitude than the pressure in the stomach, an injection chamber (phrenic ampulla) arises above the LES. Contraction of the peristaltic wave above the ampulla allows creating a pressure above the LES that is necessary for the contracting ampulla to inject a bolus into the stomach. This is how a functional proximal sphincter (PS) of 0.5-0.7 cm in length arises above ampulla. The article describes for the first time a functional sphincter at the level of the aortic arch, which occurs in patients with GERD over the age of 50. This AES plays a role in the occurrence of nonesophageal symptoms.

Keywords

x-ray diagnosis GERD, gastroesophageal reflux disease, esophageal sphincters, esophageal pathophysiology, pH monitoring