title: Defective mucosal movement at the gastroesophageal junction in patients with gastroesophageal reflux disease.
abstract: BACKGROUND
  Little is known about the role of muscularis mucosa at the gastroesophageal junction (GEJ).
  
  
  OBJECTIVE
  To evaluate the movement of the mucosa/muscularis-mucosa/submucosa (MMS) at the GEJ in normal subjects and in patients with gastroesophageal reflux disease (GERD).
  
  
  METHODS
  Gastroesophageal junctions of 20 non-GERD subjects and 10 patients with GERD were evaluated during 5 mL swallows using two methods: in high-resolution endoluminal ultrasound and manometry, the change in the GEJ luminal pressures and cross-sectional area of esophageal wall layers were measured; in abdominal ultrasound, the MMS movement at the GEJ was analyzed.
  
  
  RESULTS
  Endoluminal ultrasound: In the non-GERD subjects, the gastric MMS moved rostrally into the distal esophagus at 2.17 s after the bolus first reached the GEJ. In GERD patients, the gastric MMS did not move rostrally into the distal esophagus. The maximum change in cross-sectional area of gastroesophageal MMS in non-GERD subjects and in GERD patients was 289 % and 183%, respectively. Abdominal ultrasound: In non-GERD subjects, the gastric MMS starts to move rostrally significantly earlier and to a greater distance than muscularis propria (MP) after the initiation of the swallow (1.75 vs. 3.00 s) and (13.97 vs. 8.91 mm). In GERD patients, there is no significant difference in the movement of gastric MMS compared to MP (6.74 vs. 6.09 mm). The independent movement of the gastric MMS in GERD subjects was significantly less than in non-GERD subjects.
  
  
  CONCLUSIONS
  In non-GERD subjects, the gastric MMS moves rostrally into the distal esophagus during deglutitive inhibition and forms a barrier. This movement of the MMS is defective in patients with GERD.
authors.affiliation: Department of Medicine (Gastroenterology), The Feinstein Institute for Medical Research, Hofstra North Shore-LIJ School of Medicine, 350 Community Drive, Manhasset, NY, 11030, USA, avegesna@nshs.edu.
authors.forename: Anil K
authors.initials: AK
authors.lastname: Vegesna
authors.forename: Hemal
authors.initials: H
authors.lastname: Patel
authors.forename: Samuel
authors.initials: S
authors.lastname: Weissman
authors.forename: Anand
authors.initials: A
authors.lastname: Patel
authors.forename: Matthew
authors.initials: M
authors.lastname: Kissel
authors.forename: Sushma
authors.initials: S
authors.lastname: Indukuri
authors.forename: Anitha
authors.initials: A
authors.lastname: Nimma
authors.forename: Qing
authors.initials: Q
authors.lastname: Dai
authors.forename: Larry S
authors.initials: LS
authors.lastname: Miller
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003679:Deglutition; D004943:Esophagogastric Junction / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D005753:Gastric Mucosa / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005764:Gastroesophageal Reflux / Q000000981:diagnostic imaging / Q000503:physiopathology*; D064368:Healthy Volunteers; D006801:Humans; D008297:Male; D009068:Movement; D014463:Ultrasonography