Magnetic resonance imaging identified abnormal gastric anatomy in patients with gastroesophageal reflux disease, according to new data.
Three-dimensional models reconstructed from MRI images revealed a wider esophagogastric insertion angle plus altered gastric morphology that could compromise reflux protection by the “flap valve” mechanism in patients with gastroesophageal reflux disease (GERD).
Investigators recruited 24 healthy volunteers and 24 patients with mild-to-moderate GERD symptoms. MRI images during a test meal were used to create 3-D models of the esophagogastric junction (EGJ), along with measurements of insertion angle, gastric orientation and volume change. High-resolution manometry (HRM) was used to assess esophageal function. Researchers used HRM and cine-MRI to assess the number of reflux events and EGJ opening.
Compared with healthy participants (55°), GERD patients (62°) had a wider esophagogastric insertion angle (+ 7° ± 3°; P=.03).
EGJ opening during reflux was greater in GERD patients than in healthy patients (19.3 mm vs. 16.8 mm; P=.04). Gastric orientation and position of insertion within the abdomen also were altered in GERD patients (both P<.05).
GERD patients had lower esophageal sphincter (LES) pressure (8 mm Hg) than that of healthy participants (20 mm Hg; difference of –12 ± 2 mm Hg; P<.0001). Intra-abdominal LES length also was shorter (–1 ± 0.3 cm; P<.0006) among GERD patients (0.9 cm) than in healthy volunteers (1.9 cm).
“Wider EGJ opening during retrograde flow would allow larger volume and more proximal reflux events that are more likely to cause symptoms, in particular regurgitation, which are not well controlled by proton pump inhibitors,” the researchers wrote.
Disclosure: Research was supported by an unrestricted research grant from AstraZeneca.