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[Gastroesophageal reflux in infancy. The physiological basis of management (author's transl)]
Insights
Gastrin regulates the lower oesophageal sphincter. Surgical correction using the gastric fundus is effective for gastro-oesophageal reflux when medical treatments fail due to sphincter immaturity.
Area of Science:
- Gastroenterology
- Endocrinology
- Physiology
Context:
- The lower oesophageal sphincter (LES) plays a crucial role in preventing gastro-oesophageal reflux.
- Gastrin, a hormone produced in the pyloric antrum, influences LES function.
- Immaturity of oesophageal fibers and the cardia can lead to LES dysfunction.
Purpose:
- To elucidate the physiological basis of gastro-oesophageal reflux (GER).
- To discuss medical and surgical treatment strategies for GER.
- To highlight the role of gastrin in LES regulation.
Summary:
- Gastrin significantly impacts the lower oesophageal sphincter's closing mechanism.
- Surgical interventions involving the gastric fundus are recommended for GER when medical management is unsuccessful due to LES immaturity.
- Understanding gastrin's hormonal effect is key to managing GER.
Impact:
- Provides a physiological rationale for surgical interventions in GER.
- Guides clinical decision-making in treating refractory GER.
- Enhances understanding of the hormonal regulation of oesophageal function.
Abstract:
Gastrin has a regulating effect on the complicated closing mechanism of the lower oesophageal sphincter. This hormone produced in G-cells of the pyloric antrum and carried by the blood stream has its greatest effect on the anterior fundus wall, cardias and the lower oesophageal sphincter. Thus, when there is a failure in the closing mechanism of the lower oesophageal sphincter produced by lacking maturity of the oesophageal fibers and the cardias zone, only those surgical procedures using the gastric fundus in order to correct the failure can guarantee a good result, if medical treatment has not been successful. The authors comment on the physiological basis of the treatment, the medical as well as the surgical one, of the gastro-oesophageal reflux.