Understanding the physiology of gastroesophageal junction is important as failure of its function is associated with reflux disease, hiatus hernia, and cancer.
Professor Kenneth McColl and colleagues investigated developments in recent years in high resolution technologies allowing measurement of luminal pressure, pH, and impedance.
One obvious deficiency is the lack of technique to monitor the movement and location of the gastroesophageal junction over a prolonged period of time.
Proximal movement of the gastroesophageal junction during peristalsis and transient lower esophageal sphincter relaxations is due to shortening of the longitudinal muscle of the esophagus.
|A new technique was validated on the bench and against the gold standard, fluoroscopy |
|Scandanavian Journal of Gastroenterology|
The team reviewed techniques for measuring shortening include fluoroscopic imaging of mucosal clip, high-frequency intraluminal ultrasound, and high resolution manometry, but these techniques have limitations.
Short segment reflux is recently found to be more common than traditional reflux and may account for the high prevalence of intestinal metaplasia and cancer seen at gastroesophageal junction.
While high resolution pHmetry is available, there is no technique that can reliably and continuously measure the position of the squamocolumnar junction.
The team noted that a new technique recently reported allowing a precise and continuous measurement of the gastroesophageal junction based on the principle of Hall effect.
Reported studies have validated its accuracy both on the bench and against the gold standard, fluoroscopy.
The team reported that it has been used alongside high resolution manometry in studying the behavior of the gastroesophageal junction during transient lower esophageal sphincter relaxations and swallows.
Professor McColl's team concludes, "While there are challenges associated with this new technique, there are promising ongoing developments."
"There is exciting time ahead in research and clinical applications for this new technique."