The Role of Transsphincteric Pressure and Proximal Gastric Volume in Acid Reflux Before and After Fundoplication  Robert C.H. Scheffer, Hein G. Gooszen, Geoff S. Hebbard, Melvin Samsom  Gastroenterology  Volume 129, Issue 6, Pages 1900-1909 (December 2005) DOI: 10.1053/j.gastro.2005.09.018 Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 1 Gastric volumes before and after ingestion of a liquid nutrient in healthy subjects (n = 20; ○) and GERD patients before (n = 20 ♦) and after fundoplication (n=20 ▵). Arrow indicates start of meal ingestion. *P < .001 fundoplication vs GERD patients before operation and healthy controls. Gastroenterology 2005 129, 1900-1909DOI: (10.1053/j.gastro.2005.09.018) Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 2 Proximal gastric volume measurements in healthy subjects (○) and GERD patients before (♦) and after fundoplication (▵). Arrow indicates start of meal ingestion. *P < .001 GERD patients vs controls and #P < .001 fundoplication patients vs controls. Gastroenterology 2005 129, 1900-1909DOI: (10.1053/j.gastro.2005.09.018) Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 3 The rate at which TLESRs occurred and the percentage of TLESRs associated with acid reflux during baseline recording and after meal ingestion among subject groups. *P < .01 baseline vs distension. †P < .001 fundoplication (FP) vs normal controls and prefundoplication GERD patients. Gastroenterology 2005 129, 1900-1909DOI: (10.1053/j.gastro.2005.09.018) Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 4 Relation between meal-induced proximal gastric volume increase and the number of TLESRs in 20 controls (○; r = 0.78; P < .01) and 20 GERD patients before fundoplication (♦; r = 0.71; P < .01). Gastroenterology 2005 129, 1900-1909DOI: (10.1053/j.gastro.2005.09.018) Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 5 Transsphincteric pressure profile during TLESRs accompanied with (♦, TLESR +) and without (□, TLESR −) acid reflux. Minus 2 and −1 represent the 2 intragastric sideholes, E1–E5 represent 5 side holes at the EGJ, and 1 and 2 represent 2 distal esophageal side holes. The grey area represents the level of the EGJ. *P < .05. Gastroenterology 2005 129, 1900-1909DOI: (10.1053/j.gastro.2005.09.018) Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 6 Transsphincteric pressure profile during TLESRs with (♦) and without (□) acid reflux in GERD patients before (A) and after (B) laparoscopic Nissen fundoplication presented as in Figure 6. *P < .01. Gastroenterology 2005 129, 1900-1909DOI: (10.1053/j.gastro.2005.09.018) Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 7 Topographic manometry and pH tracing illustrating an example of a TLESR recorded in a GERD patient before (A) and after (B) fundoplication. Position of the catheter with its lumina is presented at left from the manometric color display. The vertical dashed line represents the time the axial pressure is presented. Note that, in A, the EGJ relaxation is complete and accompanied by both a pH drop and a common cavity, whereas in B, neither condition is achieved. Only the caudal part of the EGJ does completely relax after operation, which results in a cranially located EGJ pressure barrier. Gastroenterology 2005 129, 1900-1909DOI: (10.1053/j.gastro.2005.09.018) Copyright © 2005 American Gastroenterological Association Terms and Conditions