title: Gastroesophageal flap valve is associated with gastroesophageal and gastropharyngeal reflux.
abstract: BACKGROUND
  The endoscopic grade of the gastroesophageal flap valve (GEFV) is suggested to be a good predictor of reflux status. The aim of this study was to investigate the association of the GEFV and gastroesophageal and gastropharyngeal reflux.
  
  
  METHODS
  A total of 364 patients (151 men and 233 women; mean age, 52.2 years) who underwent endoscopy, esophageal manometry, and ambulatory 24-h dual-probe pH monitoring were included. GEFV was graded I through IV using Hill's classification; then, GEFV was classified into two groups: a normal GEFV group (grades I and II) and an abnormal GEFV group (grades III and IV). Findings of endoscopy, esophageal manometry, and ambulatory pH monitoring were compared between the groups.
  
  
  RESULTS
  Increased GEFV grade was significantly associated with an increased prevalence of both reflux esophagitis and Barrett's epithelium (P < 0.001). Lower esophageal sphincter pressure was significantly lower in the abnormal GEFV group than in the normal GEFV group (P < 0.001). All variables showing gastroesophageal reflux in the distal probe were significantly higher in the abnormal GEFV group than in the normal GEFV group (P < 0.001). In addition, all variables, except the supine time of pH < 4, showing gastropharyngeal reflux in the proximal probe were significantly higher in the abnormal GEFV group than in the normal GEFV group (P < 0.001). The frequency of gastroesophageal reflux disease and of gastropharyngeal reflux disease was significantly higher in the abnormal GEFV group than in the normal GEFV group (P < 0.001).
  
  
  CONCLUSIONS
  Endoscopic grading of the GEFV is easy and provides useful information about the status of gastroesophageal and gastropharyngeal reflux.
authors.affiliation: Department of Internal Medicine, Pusan National University College of Medicine, 1-10 Ami-dong, Seo-gu, Busan, 602-739, Korea.
authors.forename: Gwang Ha
authors.initials: GH
authors.lastname: Kim
authors.forename: Dae Hwan
authors.initials: DH
authors.lastname: Kang
authors.forename: Geun Am
authors.initials: GA
authors.lastname: Song
authors.forename: Tae Oh
authors.initials: TO
authors.lastname: Kim
authors.forename: Jeong
authors.initials: J
authors.lastname: Heo
authors.forename: Mong
authors.initials: M
authors.lastname: Cho
authors.forename: Jin Seon
authors.initials: JS
authors.lastname: Kim
authors.forename: Byung Joo
authors.initials: BJ
authors.lastname: Lee
authors.forename: Soo Geun
authors.initials: SG
authors.lastname: Wang
mesh_terms: D001471:Barrett Esophagus / Q000473:pathology / Q000601:surgery; D016099:Endoscopy, Gastrointestinal; D050782:Esophageal pH Monitoring; D004943:Esophagogastric Junction / Q000473:pathology*; D004947:Esophagus / Q000473:pathology / Q000502:physiology; D005260:Female; D005764:Gastroesophageal Reflux / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008297:Male; D008365:Manometry / Q000379:methods; D008875:Middle Aged