McMahon BP, Jobe BA, Pandolfino JE, Gregersen H. Do we really understand the role of the oesophagogastric junction in disease? World J Gastroenterol 2009; 15(2): 144-150 [PMID: 19132763 DOI: 10.3748/wjg.15.144]
Corresponding Author of This Article
Barry P McMahon, Chief of Physicist/Clinical Engineer, Department of Medical Physics & Clinical Engineering, Adelaide & Meath Hospital, Tallaght, Dublin 24, Ireland. barry.mcmahon@tcd.ie
Article-Type of This Article
Guidelines Clinical Practice
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World J Gastroenterol. Jan 14, 2009; 15(2): 144-150 Published online Jan 14, 2009. doi: 10.3748/wjg.15.144
Do we really understand the role of the oesophagogastric junction in disease?
Barry P McMahon, Blair A Jobe, John E Pandolfino, Hans Gregersen
Barry P McMahon, Department of Medical Physics & Clinical Engineering, Adelaide & Meath Hospital, Tallaght, Dublin 24, Ireland
Blair A Jobe, Associate Professor of Surgery, Director of Esophageal Diagnostics & Therapeutic Endoscopy, Heart, Lung and Esophageal Surgery Institute, University of Pittsburgh Medical Centre, Shadyside Medical Building, Suite 715, Pittsburgh, PA 15232, United States
John E Pandolfino, Division of Gastroenterology, Northwestern Memorial University Hospital, 676 N. St. Clair St., Suite 1400, Chicago, IL 60611, United States
Hans Gregersen, Professor of Biomechanics, Director of Research, Mech-Sense, Aalborg Hospital Science and Innovation Centre, Søndre Skovvej 15, 9000 Aalborg, Denmark
Author contributions: McMahon BP and Jobe BA contributed equally and wrote the paper based on literature review; Pandolfino JE and Gregersen H edited and added important clinical and scientific knowledge.
Correspondence to: Barry P McMahon, Chief of Physicist/Clinical Engineer, Department of Medical Physics & Clinical Engineering, Adelaide & Meath Hospital, Tallaght, Dublin 24, Ireland. barry.mcmahon@tcd.ie
Telephone: +353-1-4145898
Fax: +353-1-4142501
Received: September 10, 2008 Revised: November 18, 2008 Accepted: November 25, 2008 Published online: January 14, 2009
Abstract
The role of the oesophago-gastric junction (OGJ) in gastro-oesophageal reflux disease is still not completely understood, and there is no clinically used method to assess the OGJ function in patients. Only indirect methods such as pH studies are carried out. The OGJ acts a valve controlling the flow of solids, liquids and gases between the oesophagus and the stomach. Manometry can determine if a sphincter is toned or relaxed; but, it cannot confirm that the sphincter region is actually open. Distension is a new technique for measuring function in the OGJ. By measuring the cross-sectional area through the narrow region in the junction during distension of a catheter mounted bag, much more information on the opening and closing patterns of the junction can be determined. This technique has already been demonstrated to show changes in the OGJ after surgical treatments for reflux disease. New measurement ideas around the concept of distending the OGJ offer new hope that a clinically useable test for compliance at the junction can be developed and could potentially help in determining appropriate therapy.
