Which of the following does not help in the prevention of reflux esophagitis?
The principal barrier to reflux is the lower esophageal sphincter. LES comprises the lower 4 cm of esophagus, where resting pressure within the lumen normally exceeds the intragastric pressure. This high intraluminal pressure at LES prevents the GE reflux. The LES is a physiological entity rather than any anatomical structure. Factors contribute to the high intraluminal pressure of LES: Intrinsic musculature of distal esophagus: these muscles differ from those in the other area of the esophagus in that they are in a state of tonic contraction. They normally relax with initiation of the a swallow and then return to a state of tonic contraction. Sling fibres of cardia Crura of the diaphragm Intra Abdominal pressure: the intra abdominal pressure compresses the abdominal segment of the esophagus and is probably the most impoant factor in preventing the reflux. The gastroesophageal angle: the oblique entry of the esophagus has a valvular effect, in that it closes the esophagus when gastric fundus distends. Folds of the mucosa at the cardia : helps in closing the LES when intragastric pressure arises. Intrathoracic pressure has no role in preventing reflux as it is too low ranging from -5 to + 5mm of Hg Ref: Sabiston 18/e, Page 1108 ; Essential of Surgery By Sunil Chumber 1/e, Page 7 ; Textbook of Surgery By S. Das 3/e, Page 790
Long intraabdominal esophagus
Increased intraabdominal pressure
Right crus of diaphragm
Increased intrathoracic pressure