{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T07:15:45Z","timestamp":1776323745575,"version":"3.50.1"},"reference-count":38,"publisher":"American Physiological Society","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["American Journal of Physiology-Gastrointestinal and Liver Physiology"],"published-print":{"date-parts":[[2005,7]]},"abstract":"<jats:p> Fundoplication (FP) efficacy is a trade-off between protection against reflux and postoperative dysphagia from the surgically altered mechanical balance within the esophagogastric segment. The purpose of the study was to contrast quantitatively the mechanical balance between normal and post-FP esophageal emptying. Physiological data were combined with mathematical models based on the laws of mechanics. Seven normal controls (NC) and seven post-FP patients underwent concurrent manometry and fluoroscopy. Temporal changes in geometry of the distal bolus cavity and hiatal canal, and cavity-driving pressure were quantified during emptying. Mathematical models were developed to couple cavity pressure to hiatal geometry and esophageal emptying and to determine cavity muscle tone. We found that the average length of the hiatal canal post-FP was twice that of NC; reduction of hiatal radius was not significant. All esophageal emptying events post-FP were incomplete (51% retention); there was no significant difference in the period of emptying between NC and post-FP, and average emptying rates were 40% lower post-FP. The model predicted three distinct phases during esophageal emptying: hiatal opening ( phase I), a quasi-steady period ( phase II), and final emptying ( phase III). A rapid increase in muscle tone and driving pressure forced normal hiatal opening. Post-FP there was a severe impairment of cavity muscle tone causing deficient hiatal opening and flow and bolus retention. We conclude that impaired esophageal emptying post-FP follows from the inability of distal esophageal muscle to generate necessary tone rapidly. Immobilization of the intrinsic sphincter by the surgical procedure may contribute to this deficiency, impaired emptying, and possibly, dysphagia. <\/jats:p>","DOI":"10.1152\/ajpgi.00235.2004","type":"journal-article","created":{"date-parts":[[2005,2,4]],"date-time":"2005-02-04T01:25:19Z","timestamp":1107480319000},"page":"G21-G35","source":"Crossref","is-referenced-by-count":40,"title":["The mechanical basis of impaired esophageal emptying postfundoplication"],"prefix":"10.1152","volume":"289","author":[{"given":"Sudip K.","family":"Ghosh","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter J.","family":"Kahrilas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tamer","family":"Zaki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John E.","family":"Pandolfino","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raymond J.","family":"Joehl","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James G.","family":"Brasseur","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"24","reference":[{"key":"R1","unstructured":"Alexander HC, Hendler RS, Seymour NE, and Shires GT. Laparoscopic treatment of gastroesophageal reflux disease. Am Surg 63: 434\u2013440, 1997."},{"key":"R2","doi-asserted-by":"publisher","DOI":"10.1097\/00019509-199612000-00002"},{"key":"R3","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-196610000-00011"},{"key":"R4","doi-asserted-by":"publisher","DOI":"10.1007\/BF02493487"},{"key":"R5","doi-asserted-by":"publisher","DOI":"10.1016\/0016-5085(85)90143-X"},{"key":"R6","doi-asserted-by":"publisher","DOI":"10.1148\/94.2.261"},{"key":"R7","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-198607000-00002"},{"key":"R8","doi-asserted-by":"publisher","DOI":"10.1172\/JCI107152"},{"key":"R9","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1974.37.3.378"},{"key":"R10","unstructured":"Dusey MP. Numerical Analysis of Lubrication Theory and Peristaltic Transport in the Esophagus (PhD Thesis). University Park, PA: The Pennsylvania State Univ. 1993."},{"key":"R11","doi-asserted-by":"publisher","DOI":"10.1152\/ajpgi.1991.260.3.G512"},{"key":"R12","unstructured":"Gotley DC, Smithers BM, Menzies B, Branicki FJ, Rhodes M, and Nathanson L. Laproscopic Nissen fundoplication and postoperative dysphagia\u2013can it be predicted? Ann Acad Med Singapore 25: 646\u2013649, 1996."},{"key":"R13","doi-asserted-by":"publisher","DOI":"10.1115\/1.2835072"},{"key":"R14","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-199607000-00008"},{"key":"R15","unstructured":"Kadirkamanathan SS, Evans DF, and Swain CP. The mechanical model of gastroesophageal reflux: what are the most important factors causing gastroesophageal reflux? In: The Esophagogastric Junction 420 Questions\u2013420 Answers, edited by Giuli R, Galmiche JP, Jamieson GG, and Montrogue SC. Paris: John Libbey Eurotext, 1998, pp. 340\u2013345."},{"key":"R16","doi-asserted-by":"publisher","DOI":"10.1152\/ajpgi.1998.275.6.G1386"},{"key":"R17","doi-asserted-by":"publisher","DOI":"10.1136\/gut.44.4.476"},{"key":"R18","doi-asserted-by":"crossref","unstructured":"Li M and Brasseur JG. Nonsteady peristaltic transport in finite length tubes. J Fluid Mech 248: 129\u2013151, 1992.","DOI":"10.1017\/S0022112093000710"},{"key":"R19","doi-asserted-by":"publisher","DOI":"10.1152\/ajpgi.1994.266.4.G525"},{"key":"R20","doi-asserted-by":"publisher","DOI":"10.1007\/BF02493417"},{"key":"R21","doi-asserted-by":"publisher","DOI":"10.1152\/ajpgi.1995.268.2.G320"},{"key":"R22","doi-asserted-by":"publisher","DOI":"10.3109\/00365529309098281"},{"key":"R23","doi-asserted-by":"publisher","DOI":"10.1152\/ajpgi.1995.269.4.G577"},{"key":"R24","unstructured":"Nicosia MA. Muscle Mechanics and Modeling of the Esophagus During Swallowing (PhD Thesis). University Park, PA: The Pennsylvania State Univ. 1997."},{"key":"R25","doi-asserted-by":"publisher","DOI":"10.1006\/jtbi.2002.3118"},{"key":"R26","doi-asserted-by":"publisher","DOI":"10.1152\/ajpgi.2001.281.4.G1022"},{"key":"R27","doi-asserted-by":"crossref","unstructured":"Pal A and Brasseur JG. The mechanical advantage of local longitudinal shortening on peristaltic transport. J Biomech Eng 24: 94\u2013100, 2002.","DOI":"10.1115\/1.1427700"},{"key":"R28","doi-asserted-by":"publisher","DOI":"10.1152\/ajpgi.00279.2001"},{"key":"R29","doi-asserted-by":"crossref","unstructured":"Panton RL. Incompressible Flow. New York: Wiley, 1996.","DOI":"10.1063\/1.881530"},{"key":"R30","doi-asserted-by":"publisher","DOI":"10.1097\/00019509-199702000-00005"},{"key":"R31","doi-asserted-by":"publisher","DOI":"10.1007\/BF02071548"},{"key":"R32","doi-asserted-by":"publisher","DOI":"10.1152\/ajpgi.1991.261.3.G417"},{"key":"R33","doi-asserted-by":"publisher","DOI":"10.1152\/ajpgi.1993.264.3.G407"},{"key":"R34","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2982.2002.00351.x"},{"key":"R35","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-117-12-997"},{"key":"R36","doi-asserted-by":"publisher","DOI":"10.1006\/jsre.2000.5907"},{"key":"R37","doi-asserted-by":"crossref","unstructured":"Ulerich R, Dai Q, Miller LS, and Brasseur JG. Detailed 3-D Anatomy of the Human Gastro-Esophageal Segment (Abstract). Gastroenterology 124, Suppl, S: A259, 2003.","DOI":"10.1016\/S0016-5085(03)81298-2"},{"key":"R38","unstructured":"White FM. Fluid Mechanics. New York: McGraw-Hill, 1999."}],"container-title":["American Journal of Physiology-Gastrointestinal and Liver Physiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.physiology.org\/doi\/pdf\/10.1152\/ajpgi.00235.2004","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,9,9]],"date-time":"2019-09-09T00:57:48Z","timestamp":1567990668000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.physiology.org\/doi\/10.1152\/ajpgi.00235.2004"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2005,7]]},"references-count":38,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2005,7]]}},"alternative-id":["10.1152\/ajpgi.00235.2004"],"URL":"https:\/\/doi.org\/10.1152\/ajpgi.00235.2004","relation":{},"ISSN":["0193-1857","1522-1547"],"issn-type":[{"value":"0193-1857","type":"print"},{"value":"1522-1547","type":"electronic"}],"subject":[],"published":{"date-parts":[[2005,7]]}}}