{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T07:34:45Z","timestamp":1767339285481,"version":"3.41.2"},"reference-count":24,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2016,7,14]],"date-time":"2016-07-14T00:00:00Z","timestamp":1468454400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"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\/501100003545","name":"Minist\u00e9rio da Ci\u00eancia, Tecnologia e Inova\u00e7\u00e3o","doi-asserted-by":"publisher","award":["481098\/2009\u20107"],"award-info":[{"award-number":["481098\/2009\u20107"]}],"id":[{"id":"10.13039\/501100003545","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2017,1]]},"abstract":"Abstract<\/jats:title>Background<\/jats:title>Inspiratory esophagogastric junction (EGJ<\/jats:styled-content>) pressure is lower in gastroesophageal reflux disease (GERD<\/jats:styled-content>) and patients fail to increase EGJ<\/jats:styled-content> pressure during the inspiratory effort. The aim of this study was to assess the EGJ<\/jats:styled-content> activity during inspiratory maneuvers (high\u2010resolution manometry, HRM<\/jats:styled-content>) and the crural diaphragm (CD<\/jats:styled-content>) thickness (endoscopic ultrasound, EUS<\/jats:styled-content>) in GERD<\/jats:styled-content>.<\/jats:p><\/jats:sec>Methods<\/jats:title>Twenty esophagitis patients (average age 45\u00a0years, 7 grade A, 13 grade B) had HRM<\/jats:styled-content> and EUS<\/jats:styled-content>. Forty\u2010three controls were recruited; 30 had HRM<\/jats:styled-content> (average age 33\u00a0years), and 13 had EUS<\/jats:styled-content> (average age 40\u00a0years). The EGJ<\/jats:styled-content> contractility index (EGJ<\/jats:styled-content>\u2010CI<\/jats:styled-content>) (mm Hg\u00d7cm) was measured during normal respiration and two inspiratory maneuvers: without and with inspiratory loads of 12, 24, and 48\u00a0cmH2<\/jats:sub>O (TH<\/jats:styled-content>\u2010maneuvers). A composite metric for TH<\/jats:styled-content>\u2010maneuvers (\u201cEGJ<\/jats:styled-content> total activity\u201d) was defined as the product of the maximal EGJ<\/jats:styled-content> pressure and the length of its aboral excursion during the maneuver (mm Hg\u00d7cm). The CD<\/jats:styled-content> thickness (cm) was measured during expiration (12\u00a0MHz).<\/jats:p><\/jats:sec>Key Results<\/jats:title>Expiratory lower esophageal sphincter pressure and integrated relaxation pressure were lower in GERD<\/jats:styled-content>. The EGJ<\/jats:styled-content>\u2010CI<\/jats:styled-content> and the \u201cEGJ<\/jats:styled-content> total activity\u201d were lower in GERD<\/jats:styled-content> during TH<\/jats:styled-content>\u2010maneuvers (48\u2010cmH2<\/jats:sub>O load: 168.4\u00a0\u00b1\u00a013.8 vs 114.8\u00a0\u00b1\u00a09.6, P<\/jats:italic>=.006). Patients failed to sustain the inspiratory CD<\/jats:styled-content> activity across the 12 and 48\u2010cmH2<\/jats:sub>O efforts. The CD<\/jats:styled-content> was thinner in GERD<\/jats:styled-content> patients (0.37\u00a0\u00b1\u00a00.03 vs 0.49\u00a0\u00b1\u00a00.04, P<\/jats:italic>=.02). The CD<\/jats:styled-content> thickness correlated with the increment in the \u201cEGJ<\/jats:styled-content> total activity\u201d in GERD<\/jats:styled-content> without a hiatal hernia (r<\/jats:italic>=.702, P<\/jats:italic>=.016, n=11).<\/jats:p><\/jats:sec>Conclusions & Inferences<\/jats:title>There are anatomical changes and functional failure of the CD<\/jats:styled-content> in esophagitis patients supporting the possibility of a skeletal muscle deficiency in GERD<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nmo.12899","type":"journal-article","created":{"date-parts":[[2016,7,15]],"date-time":"2016-07-15T01:27:07Z","timestamp":1468546027000},"source":"Crossref","is-referenced-by-count":17,"title":["Anatomical and functional deficiencies of the crural diaphragm in patients with esophagitis"],"prefix":"10.1111","volume":"29","author":[{"given":"M. \u00c2. N.","family":"e Souza","sequence":"first","affiliation":[{"name":"Department of Clinical Medicine Federal University of Cear\u00e1 Fortaleza Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R. A.","family":"Nobre","sequence":"additional","affiliation":[{"name":"Fortaleza University (UNIFOR) Fortaleza Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P. C.","family":"Bezerra","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine Federal University of Cear\u00e1 Fortaleza Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A. A.","family":"dos Santos","sequence":"additional","affiliation":[{"name":"Department of Physiology and Pharmacology Federal University of Cear\u00e1 Fortaleza Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D.","family":"Sifrim","sequence":"additional","affiliation":[{"name":"Queen Mary University of London London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2016,7,14]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2006.09.016"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2006.00630.x"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1172\/JCI113433"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5085(03)01210-1"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2007.01138.x"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v21.i7.2067"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2008.11.002"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpgi.00054.2013"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2011.420"},{"key":"e_1_2_9_11_1","first-page":"217","article-title":"Quality of life scale for gastroesophageal reflux disease","volume":"183","author":"Velanovich V","year":"1996","journal-title":"J Am Coll Surg"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1590\/S0004-28032004000400012"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1590\/S0004-28032007000200016"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12477"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12267"},{"volume-title":"Endosonography","year":"2014","author":"Hawes R","key":"e_1_2_9_16_1"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2012.08.023"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/thx.50.11.1157"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1007236"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.154.5.8912741"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199109263251304"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00173.2009"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.phrs.2015.05.010"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.resp.2013.06.025"},{"key":"e_1_2_9_25_1","unstructured":"AlvesMNM AndradeMC LeandroJRA et\u00a0al.Upper gastrointestinal inflammation is related to crural diaphragm muscle atrophy (abstract). 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