oesophagogastric junction

There is controversy over the precise location of the true oesophagogastric junction or 'cardia' in patients with reflux oesophagitis.

Twenty six patients with Barrett's columnar lined lower oesophagus were diagnosed by endoscopic documentation of the squamocolumnar junction being circumferentially more than 3 cm above the endoscopically determined anatomical oesophagogastric junction.

For gastroenterologists and surgeons who perform manometric studies, the distal end of the lowr oesophageal sphincter, which has an abdominal portion of 1 to 2 cm long, is the true oesophagogastric junction.

It must be clear that the squamous columnar junction does not represent the true oesophagogastric junction or cardia, as it has been previously demonstrated by simultaneous determination of potential difference change and manometric studies.

Slipping was registered when there was a distinct gastric pouch above the narrowing caused by the folds of the wrap, and disruption implied no visible folds or only distorted, loose folds at the oesophagogastric junction.

Savary-Miller grading of the oesophageal mucisa was confirmed by biopy specimens taken from all macroscopic lsions and also a few centimetre proximal to them or, if no lesions were visible, from a site 3-5 cm above the oesophagogastric junction.

For many endoscopists, the squamous columnar junction is considered as the representative of the oesophagogastric junction and the segment distal to it is frequently thought of as a 'hiatal hernia', because of the presence of gastric mucosa.

Under direct vision of the oesophagogastric junction and simultaneous manometric measurements, it is possible to observe a very similar correlation among the location of the lower oesophageal sphincter measured before operation with the values measured during surgery and under a direct observation.

This is why the distal ring noted by some authors is only a mucosal stricture, which marks only the mucosal junction and not the true muscular oesophagogastric junction as observed by Reinaldo and Gahagan. and Harris.

Endoscopy in the diagnosis of a Barrett's oesophagus is more precise, but when the distal oesophagus is dilated, which is a usual finding in these cases and a hypotensive lower oesophageal sphincter is present, it is more difficult to detect the true oesophagogastric junction or cardia.

The distal end of the lower oesophageal sphincter represents the true oesophagogastric junction or cardia and if the squamous columnar junction is located 3 cm or more proximal to the proximal limit of this sphincter, a true Barrett's oesophagus is present, which has been our criteria.