L'indagine radiologica nella valutazione morfo-funzionale della giunzione esofago-gastrica nella malattia da reflusso gastro-esofageo

Translated title of the contribution: Radiological examinations in the morphofunctional evaluation of the esophago-gastric junction in gastro-esophageal reflux disease

Stefano Brusori, Sandro Mattioli, Francesco Bassi, Claudio Bnà, Massimo P. Di Simone, Maria Luisa Lugaresi, Franco D'Ovidio, Giampaolo Gavelli

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Purpose. The aim of our paper is to define, on the basis of a long experience, the anatomical and radiological classification of the progressive phases of the axial intrathoracic migration of the esophago-gastric junction (EGJ), through a standardised radiological method that allows precise identification of the anatomical structures involved. Materials and methods. From 1981 to 2001, 1388 patients with gastro-esophageal reflux disease (GERD) were examined by traditional contrast techniques that consisted in taking single contrast radiograms of the patients in different positions after administering a small high-density bolus of barium: with the patient standing up in frontal position, at rest, during forced inspiration, and during straining; standing up in a right front 30° oblique position: and in prone position, in a right posterior 30° oblique projection. On the basis of previous radiological and manometric studies aimed at verifying the diagnostic reliability of the radiological examination [8], the distance of the esophago-gastric junction from the esophageal hiatus was indirectly evaluated in an anterior-posterior projection, according to the criteria introduced by Monges [3]. The sling fibers, which form a radiologically detectable cut at the apex of the angle of His, are the lowest portion of the EGJ. Results. On the basis of the radiological findings, and in agreement with the radiological classifications reported in the literature, we evidenced five groups, with pathologically characteristic signs: - 1st group (63%) patients who in orthostatic position have an EGJ regularly placed within the abdomen (16%). and patients with the EGJ regularly placed within the abdomen, but with a small sliding intermittent hiatus hernia (47%); - 2nd group (13%) cardial tuberosity malposition; - 3rd group (7%) concentric hiatus hernia; - 4th group (8%) acquired short esophagus; - 5th group (9%) massive incarcerated gastric hiatus hernia. Conclusions. Traditional radiography, performed with an adequate technique and with the necessary expedients, allows for the correct interpretation of the anatomical disoder called GERD, and is therefore the first diagnostic approach in defining correct patient management.

Original languageItalian
Pages (from-to)385-393
Number of pages9
JournalRadiologia Medica
Volume104
Issue number5-6
Publication statusPublished - Nov 2002

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Esophageal Diseases
Gastroesophageal Reflux
Stomach
Hiatal Hernia
Abdomen
Prone Position
Barium
Radiography
Esophagus

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Brusori, S., Mattioli, S., Bassi, F., Bnà, C., Di Simone, M. P., Lugaresi, M. L., ... Gavelli, G. (2002). L'indagine radiologica nella valutazione morfo-funzionale della giunzione esofago-gastrica nella malattia da reflusso gastro-esofageo. Radiologia Medica, 104(5-6), 385-393.

L'indagine radiologica nella valutazione morfo-funzionale della giunzione esofago-gastrica nella malattia da reflusso gastro-esofageo. / Brusori, Stefano; Mattioli, Sandro; Bassi, Francesco; Bnà, Claudio; Di Simone, Massimo P.; Lugaresi, Maria Luisa; D'Ovidio, Franco; Gavelli, Giampaolo.

In: Radiologia Medica, Vol. 104, No. 5-6, 11.2002, p. 385-393.

Research output: Contribution to journalArticle

Brusori, S, Mattioli, S, Bassi, F, Bnà, C, Di Simone, MP, Lugaresi, ML, D'Ovidio, F & Gavelli, G 2002, 'L'indagine radiologica nella valutazione morfo-funzionale della giunzione esofago-gastrica nella malattia da reflusso gastro-esofageo', Radiologia Medica, vol. 104, no. 5-6, pp. 385-393.
Brusori S, Mattioli S, Bassi F, Bnà C, Di Simone MP, Lugaresi ML et al. L'indagine radiologica nella valutazione morfo-funzionale della giunzione esofago-gastrica nella malattia da reflusso gastro-esofageo. Radiologia Medica. 2002 Nov;104(5-6):385-393.
Brusori, Stefano ; Mattioli, Sandro ; Bassi, Francesco ; Bnà, Claudio ; Di Simone, Massimo P. ; Lugaresi, Maria Luisa ; D'Ovidio, Franco ; Gavelli, Giampaolo. / L'indagine radiologica nella valutazione morfo-funzionale della giunzione esofago-gastrica nella malattia da reflusso gastro-esofageo. In: Radiologia Medica. 2002 ; Vol. 104, No. 5-6. pp. 385-393.
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abstract = "Purpose. The aim of our paper is to define, on the basis of a long experience, the anatomical and radiological classification of the progressive phases of the axial intrathoracic migration of the esophago-gastric junction (EGJ), through a standardised radiological method that allows precise identification of the anatomical structures involved. Materials and methods. From 1981 to 2001, 1388 patients with gastro-esophageal reflux disease (GERD) were examined by traditional contrast techniques that consisted in taking single contrast radiograms of the patients in different positions after administering a small high-density bolus of barium: with the patient standing up in frontal position, at rest, during forced inspiration, and during straining; standing up in a right front 30° oblique position: and in prone position, in a right posterior 30° oblique projection. On the basis of previous radiological and manometric studies aimed at verifying the diagnostic reliability of the radiological examination [8], the distance of the esophago-gastric junction from the esophageal hiatus was indirectly evaluated in an anterior-posterior projection, according to the criteria introduced by Monges [3]. The sling fibers, which form a radiologically detectable cut at the apex of the angle of His, are the lowest portion of the EGJ. Results. On the basis of the radiological findings, and in agreement with the radiological classifications reported in the literature, we evidenced five groups, with pathologically characteristic signs: - 1st group (63{\%}) patients who in orthostatic position have an EGJ regularly placed within the abdomen (16{\%}). and patients with the EGJ regularly placed within the abdomen, but with a small sliding intermittent hiatus hernia (47{\%}); - 2nd group (13{\%}) cardial tuberosity malposition; - 3rd group (7{\%}) concentric hiatus hernia; - 4th group (8{\%}) acquired short esophagus; - 5th group (9{\%}) massive incarcerated gastric hiatus hernia. Conclusions. Traditional radiography, performed with an adequate technique and with the necessary expedients, allows for the correct interpretation of the anatomical disoder called GERD, and is therefore the first diagnostic approach in defining correct patient management.",
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