title: Continuous imaging of esophagogastric junction in patients with reflux esophagitis using 320-row area detector CT: a feasibility study.
abstract: OBJECTIVE
  The function of the lower esophageal sphincter (LES) is evaluated using an esophageal manometric study. However, information regarding the surrounding organs is difficult to obtain with use of a sensor catheter. We investigated the utility of 320-row area detector computed tomography (CT) to evaluate morphological changes of the esophagogastric junction and surrounding organs.
  
  
  METHODS
  The study subjects were 18 healthy volunteers and 29 patients with reflux esophagitis (RE). Immediately after swallowing a diluted contrast agent, continuous imaging of the esophagogastric junctional area was performed for 15 s. Using CT images, the presence or absence of esophageal hiatal hernia, His angle before and after swallowing, size of the diaphragmatic hiatus, morphologically identified-LES (MI-LES) length, intraluminal horizontal area of MI-LES during relaxation phase, MI-LES thickness, abdominal esophagus length, subcutaneous fat area, visceral fat area, and esophagogastric junction fat area were evaluated.
  
  
  RESULTS
  Analysis of CT images showed more frequent occurrence of hiatal hernia, greater His angle, and a larger diaphragmatic hiatus in patients with severe RE, while the lengths of MI-LES and abdominal esophagus were shorter in those patients. Visceral and esophagogastric junction fat areas tended to be greater in patients with RE. In all subjects, the posterior wall of the MI-LES was thicker than the anterior wall.
  
  
  CONCLUSIONS
  Continuous imaging with 320-row area detector CT is useful to evaluate morphological changes in the esophagogastric junction area in both normal individuals and patients with reflux esophagitis.
authors.affiliation: Second Department of Internal Medicine, Shimane University Faculty of Medicine, Izumo, Shimane, Japan.
authors.forename: Kousuke
authors.initials: K
authors.lastname: Fukazawa
authors.forename: Kenji
authors.initials: K
authors.lastname: Furuta
authors.forename: Kyoichi
authors.initials: K
authors.lastname: Adachi
authors.forename: Shino
authors.initials: S
authors.lastname: Shimura
authors.forename: Kazutoshi
authors.initials: K
authors.lastname: Kamiyama
authors.forename: Masahito
authors.initials: M
authors.lastname: Aimi
authors.forename: Shunji
authors.initials: S
authors.lastname: Ohara
authors.forename: Takafumi
authors.initials: T
authors.lastname: Kajitani
authors.forename: Masakatsu
authors.initials: M
authors.lastname: Tsurusaki
authors.forename: Hajime
authors.initials: H
authors.lastname: Kitagaki
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Kinoshita
mesh_terms: D000368:Aged; D003679:Deglutition / Q000502:physiology; D049630:Esophageal Sphincter, Lower / Q000473:pathology / Q000503:physiopathology; D004942:Esophagitis, Peptic / Q000150:complications / Q000000981:diagnostic imaging*; D004943:Esophagogastric Junction / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D005240:Feasibility Studies; D005260:Female; D006551:Hernia, Hiatal / Q000150:complications / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D055815:Young Adult
keywords: His angle; computed tomography; gastroesophageal reflux; hiatus hernia; lower esophageal sphincter