title: Diagnosis of Gastroesophageal Reflux Disease Using Real-time Magnetic Resonance Imaging.
abstract: A small angle (His angle) between the oesophagus and the fundus of the stomach is considered to act as flap valve and anti-reflux barrier. A wide angle results in dysfunction of the oesophagogastric junction and subsequently in gastroesophageal reflux disease (GERD). Here, we used real-time magnetic resonance imaging (MRI) at 50 ms resolution (20 frames per second) in 12 volunteers and 12 patients with GERD to assess transport of pineapple juice through the oesophagogastric junction and reflux during Valsalva. We found that the intra-abdominal part of the oesophagus was bended towards the left side resulting in an angle of 75.3 ± 17.4, which was significantly larger during Valsava (P = 0.017). Reflux and several underlying pathologies were detected in 11 out of 12 patients. Our data visualize oesophagogastric junction physiology and disprove the flap valve hypothesis. Further, non-invasive real-time MRI has considerable potential for the diagnosis of causative pathologies leading to GERD.
authors.affiliation: Biomedizinische NMR Forschungs GmbH am Max-Planck-Institut für biophysikalische Chemie, Göttingen, Germany.
authors.forename: Shuo
authors.initials: S
authors.lastname: Zhang
authors.affiliation: Biomedizinische NMR Forschungs GmbH am Max-Planck-Institut für biophysikalische Chemie, Göttingen, Germany.
authors.forename: Arun A
authors.initials: AA
authors.lastname: Joseph
authors.affiliation: Department of Surgery, University Medical Center, Göttingen, Germany.
authors.forename: Lisa
authors.initials: L
authors.lastname: Gross
authors.affiliation: Department of Surgery, University Medical Center, Göttingen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Ghadimi
authors.affiliation: Biomedizinische NMR Forschungs GmbH am Max-Planck-Institut für biophysikalische Chemie, Göttingen, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Frahm
authors.affiliation: Department of Surgery, University Medical Center, Göttingen, Germany.
authors.forename: Alexander W
authors.initials: AW
authors.lastname: Beham
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D004943:Esophagogastric Junction / Q000502:physiology; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D011859:Radiography; D055815:Young Adult