{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T12:45:55Z","timestamp":1785329155883,"version":"3.55.0"},"reference-count":17,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2023,8,1]],"date-time":"2023-08-01T00:00:00Z","timestamp":1690848000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100003593","name":"Conselho Nacional de Desenvolvimento Cient\u00edfico e Tecnol\u00f3gico","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003593","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005283","name":"Funda\u00e7\u00e3o Cearense de Apoio ao Desenvolvimento Cient\u00edfico e Tecnol\u00f3gico","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100005283","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,1,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Low sphincter pressure and inability of the crural diaphragm to elevate it at the esophagogastric junction are important pathophysiological mechanisms of gastroesophageal reflux disease (GERD). The object of this study was to depict how Nissen fundoplication changed the resting and inspiratory pressures of the anti-reflux barrier. We selected 14 patients (eight males; mean age 42.7\u00a0years; mean body mass index 27.8) for surgery. They answered symptoms questionnaires and underwent high-resolution manometry (HRM) before and 6\u00a0months after Nissen fundoplication. We used a standard manometric protocol (resting and liquid swallows) and assessment of esophagogastric junction (EGJ) pressure metrics during standardized forced inspiratory maneuvers against increasing loads (Threshold Maneuvers). We used the Wilcoxon test for comparison of pre and postoperative data. After fundoplication, heartburn and regurgitation scores diminished remarkably (from 4.5 and 2, respectively, to zero; P\u2009=\u20090.002 and P\u2009=\u20090.0005, respective medians). Also, the median expiratory EGJ pressure had a significant increase from 8.1 to 18.1\u00a0mmHg (P\u2009=\u20090.002), while mean respiratory pressure and EGJ contractility integral (EGJ-CI) increased without statistical significance (P\u2009=\u20090.064 and P\u2009=\u20090.06, respectively). Axial EGJ displacement was lower after fundoplication. The EGJ relaxation pressure (P\u2009=\u20090.001), the mean distal esophageal intrabolus pressure (P\u2009=\u20090.01) and the distal latency (P\u2009=\u20090.017) increased after fundoplication. There was a reduction in the contraction front velocity (P\u2009=\u20090.043). During evaluation with standardized inspiratory maneuvers, the inspiratory EGJ pressures (under loads of 12, 24, 36 and 48 cmH2O) were lower after surgery for all loads (median for load 12 cmH2O: 145.6 vs. 102.7\u00a0mmHg; P =\u20090.004). Fundoplication and hiatal closure increased the expiratory EGJ pressure and promoted a great GERD symptom relief. The surgery seemed to overcompensate a reduced EGJ mobility and inspiratory pressure.<\/jats:p>","DOI":"10.1093\/dote\/doad051","type":"journal-article","created":{"date-parts":[[2023,8,2]],"date-time":"2023-08-02T07:26:15Z","timestamp":1690961175000},"source":"Crossref","is-referenced-by-count":2,"title":["Pressure dynamics of the esophagogastric junction at rest and during inspiratory maneuvers after Nissen fundoplication"],"prefix":"10.1093","volume":"37","author":[{"given":"Leonardo Adolpho","family":"S\u00e1 Sales","sequence":"first","affiliation":[{"name":"Walter Cant\u00eddio University Hospital, Federal University of Cear\u00e1 , Fortaleza , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando Ant\u00f4nio Siqueira","family":"Pinheiro","sequence":"additional","affiliation":[{"name":"Surgery Department, Federal University of Cear\u00e1 , Fortaleza , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo\u00e3o Odilo Gon\u00e7alves","family":"Pinto","sequence":"additional","affiliation":[{"name":"Walter Cant\u00eddio University Hospital, Federal University of Cear\u00e1 , Fortaleza , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arm\u00eanio Aguiar","family":"Santos","sequence":"additional","affiliation":[{"name":"Physiology and Pharmacology Department, Federal University of Cear\u00e1 , Fortaleza , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel \u00c2ngelo Nobre","family":"Souza","sequence":"additional","affiliation":[{"name":"Clinical Medicine Department, Federal University of Cear\u00e1 , Fortaleza , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,8,1]]},"reference":[{"issue":"4","key":"2024010308293462600_ref1","doi-asserted-by":"crossref","first-page":"499","DOI":"10.5056\/jnm19081","article-title":"Esophageal motor dysfunctions in gastroesophageal reflux disease and therapeutic perspectives","volume":"25","author":"Lin","year":"2019","journal-title":"J Neurogastroenterol Motil"},{"issue":"10","key":"2024010308293462600_ref2","doi-asserted-by":"crossref","first-page":"doab006","DOI":"10.1093\/dote\/doab006","article-title":"Severity of GERD and disease progression","volume":"34","author":"Fuchs","year":"2021","journal-title":"Dis Esophagus"},{"issue":"4","key":"2024010308293462600_ref3","doi-asserted-by":"crossref","first-page":"1182","DOI":"10.1172\/JCI113433","article-title":"Electrical and mechanical activity in the human lower esophageal sphincter during diaphragmatic contraction","volume":"81","author":"Mittal","year":"1988","journal-title":"J Clin Invest"},{"issue":"5","key":"2024010308293462600_ref4","doi-asserted-by":"crossref","first-page":"1056","DOI":"10.1111\/j.1572-0241.2007.01138.x","article-title":"High-resolution manometry of the EGJ: an analysis of crural diaphragm function in GERD","volume":"102","author":"Pandolfino","year":"2007","journal-title":"Am J Gastroenterol"},{"issue":"11","key":"2024010308293462600_ref5","doi-asserted-by":"crossref","first-page":"G862","DOI":"10.1152\/ajpgi.00054.2013","article-title":"Inspiratory muscle training improves antireflux barrier in GERD patients","volume":"305","author":"Nobre e Souza","year":"2013","journal-title":"Am J Physiol Gastrointest Liver Physiol"},{"issue":"1","key":"2024010308293462600_ref6","doi-asserted-by":"crossref","first-page":"e12899","DOI":"10.1111\/nmo.12899","article-title":"Anatomical and functional deficiencies of the crural diaphragm in patients with esophagitis","volume":"29","author":"Souza","year":"2017","journal-title":"Neurogastroenterol Motil"},{"issue":"8","key":"2024010308293462600_ref7","doi-asserted-by":"crossref","first-page":"1677","DOI":"10.1111\/j.1572-0241.2005.42009.x","article-title":"Impaired bolus transit across the esophagogastric junction in post fundoplication dysphagia","volume":"100","author":"Scheffer","year":"2005","journal-title":"Am J Gastroenterol"},{"issue":"12","key":"2024010308293462600_ref8","doi-asserted-by":"crossref","first-page":"3642","DOI":"10.1007\/s00464-012-2388-z","article-title":"Impaired postoperative EGJ relaxation as determinant of post laparoscopic fundoplication dysphagia: a study with high-resolution manometry before and after surgery","volume":"26","author":"Marjoux","year":"2012","journal-title":"Surg Endosc"},{"issue":"2","key":"2024010308293462600_ref9","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1038\/ajg.2009.656","article-title":"Pediatric esophageal high-resolution manometry: utility of a standardized protocol and size-adjusted pressure topography parameters","volume":"105","author":"Goldani","year":"2010","journal-title":"Am J 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Motil"},{"issue":"3","key":"2024010308293462600_ref13","first-page":"138","article-title":"Laparoscopic Nissen fundoplication: preliminary report","volume":"1","author":"Dallemagne","year":"1991","journal-title":"Surg Laparosc Endosc"},{"issue":"1","key":"2024010308293462600_ref14","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/dote\/doab032","article-title":"Primary laparoscopic fundoplication in selected patients with gastroesophageal reflux disease","volume":"35","author":"Fuchs","year":"2022","journal-title":"Dis Esophagus"},{"issue":"30","key":"2024010308293462600_ref15","doi-asserted-by":"crossref","first-page":"3745","DOI":"10.3748\/wjg.v16.i30.3745","article-title":"Gastroesophageal reflux disease: from pathophysiology to treatment","volume":"16","author":"Herbella","year":"2010","journal-title":"World J 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