title: The repercussions of spinal cord injury on the action of the diaphragmatic crura for gastroesophageal reflux containment.
abstract: METHODS
  Cross-sectional and nonexperimental.
  
  
  OBJECTIVE
  To detect and compare functional abnormalities in the esophagus and esophagogastric junction in 2 groups with chronic spinal injuries, 1 with injuries at the phrenic innervation level and the other at upper thoracic levels, and to relate these to gastroesophageal reflux containment.
  
  
  BACKGROUND
  There are no studies on esophageal manometry with pH metering among spinal cord injury patients. Worldwide statistics reveal that the prevalence of gastroesophageal reflux disease among spinal cord injury patients is greater than among the general population, at around 22% to 27%. The "diaphragmatic crura" has been recognized as an important antireflux barrier and should functionally be considered to be a muscle separated from the costal diaphragm. However, doubts remain regarding whether this difference relates to its innervation.
  
  
  METHODS
  This was a cross-sectional study on 29 patients with complete spinal cord injuries: 14 quadriplegics (level C4) and 15 paraplegics (levels T1-T7). Functional abnormalities of the esophagogastric junction, esophagus, and diaphragm were investigated using esophageal manometry and diaphragmatic video fluoroscopy. Presence of gastroesophageal reflux was investigated subjectively (pyrosis and regurgitation) and objectively (pH metering and endoscopy).
  
  
  RESULTS
  The incidence of gastroesophageal reflux disease was 27.6%, without difference between the groups. This became statistically significant when the mean diaphragmatic crural pressures were compared (quadriplegics: 37.5 +/- 17.8; paraplegics: 26.6 +/- 7.2; P = 0.048). It was also significant in relation to the prevalence of at least one of the objective and/or subjective reflux findings and/or esophageal peristaltism (quadriplegics: 85.7%; paraplegics: 40.0%; P = 0.011).
  
  
  CONCLUSIONS
  Spinal injury at the level of the phrenic innervation did not predispose the quadriplegics toward greater risk of developing gastroesophageal reflux disease. Paradoxically, manometry showed significantly greater crural contractility among the quadriplegics.
authors.affiliation: Discipline of Emergency Medicine and Evidence-Based Medicine, Hospital Sao Paulo, Brazil.
authors.forename: Cleuza B
authors.initials: CB
authors.lastname: Silva
authors.forename: Júlio C
authors.initials: JC
authors.lastname: Martinez
authors.forename: Edison T
authors.initials: ET
authors.lastname: Yanagita
authors.forename: José F
authors.initials: JF
authors.lastname: Morais
authors.forename: Luciane B
authors.initials: LB
authors.lastname: Carvalho
authors.forename: Benedito
authors.initials: B
authors.lastname: Herani-Filho
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Moraes
authors.forename: Patrícia C
authors.initials: PC
authors.lastname: Vianna
authors.forename: Gilmar F
authors.initials: GF
authors.lastname: Prado
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003964:Diaphragm / Q000502:physiology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D008297:Male; D010264:Paraplegia / Q000150:complications / Q000503:physiopathology; D011782:Quadriplegia / Q000150:complications / Q000503:physiopathology; D013119:Spinal Cord Injuries / Q000150:complications / Q000503:physiopathology*; D055815:Young Adult