J.Jpn. Surg. Soc.. 62(6): 615-626, 1961

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STUDIES ON THE ANTI-REFLUX MECHANISM EXISTING AT THE ESOPHAGO-GASTRIC JUNCTION.
EXPERIMENTAL ANALYSIS ON SOME FACTORS PARTICIPATING IN THE MECHANISM

ln this study the respective role of the muscle layers of the esophago-gastric junction, diaphragma and His' angle in the antireflux mechanism has been evaluted. To this purpose, one or two of these structures were selectively and experimentally eliminated in dogs, and intragastric pressure necessary to cause the reflux of the saline solution in the stomach into esophagus (the reflux pressure) was determined.
Results obtained were as follows :
1) The reflux pressure in the total 57 untreated dogs ranged 8 to 16 mmHg with the mean being 12.6 mmHg.
2) The esophago-gastric junction. The reflux pressure was reduced to 9.4 mmHg (79.3% of the previous value) following the dissection of the circular muscle and to 8.4 mmHg (70.0%) when dissection of the oblique muscle was added. On the other hand, when the order is reversed, the pressure became 11.4 mmHg (83.8%) by severance of the oblique muscle and 9.6 mmHg (70.5%) when circular muscle was additionally cut.
3) Diaphragma. The reflux pressure was in the mean 9.0 mmHg (67.6%) when the diaphragmatico-esophageal ligament was dissected from the esophagus, and 8.7 mmHg (65.9%) when the diaphrama was additionally cut in the left side of the esophagus. In the reversed order, the pressure was first 7.8 mmHg (61.9%) when the diaphragma was cut and 7.0 mmHg (55.5%) by additional of the ligament.
4) The interrelationship of the muscle layers and the diaphragma. The reflux pressure was in the mean 10.0 mmHg (70.4%) following the severance of the muscle layers (both oblique and circular), and was 7.2 mmHg (50.7%) by additional diaphragmatic dissection. However, when the order reversed, the pressure was 7.2 mmHg (55.3%) following the diaphragmatic dissection and 6.0 mmHg (46.1%) by additional myotomy.
5) His' angle. The increase in the His' angle due to resection of the gastric-fundus did not cause significant decrease in reflux pressure.
6) These observations may lead to the conclusion that the circular muscle of the esophagogastric junction, the oblique muscle running from here to the stomach and the diaphragma attached to the esophagus participate significantly in the anti-reflux mechanism, and impairment in any of these structures does not guarantee the normal anti-reflux mechanism.
(Author's abstract)

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