Surgery>>>>>The Esophagus and Diaphragmatic Hernia
Question 4#

All of these are parts of the human antireflux mechanism EXCEPT:

a. Adequate gastric reservoir
b. Mechanically functioning lower esophageal sphincter (LES)
c. Mucus secreting cells of the distal esophagus
d. Efficient esophageal clearance

Correct Answer is C


If the pharyngeal swallow does not initiate a peristaltic contraction, then the coincident relaxation of the lower esophageal sphincter (LES) is unguarded and reflux of gastric juice can occur. This may be an explanation for the observation of spontaneous lower esophageal relaxation, thought by some to be a causative factor in gastroesophageal reflux disease (GERD). The power of the worm-drive pump of the esophageal body is insufficient to force open a valve that does not relax. In dogs, a bilateral cervical parasympathetic blockade abolishes the relaxation of the LES that occurs with pharyngeal swallowing or distention of the esophagus. Consequently, vagal function appears to be important in coordinating the relaxation of the LES with esophageal contraction. The antireflux mechanism in human beings is composed of three components: a mechanically effective LES, efficient esophageal clearance, and an adequately functioning gastric reservoir. A defect of any one of these three components can lead to increased esophageal exposure to gastric juice and the development of mucosal injury.