Anatomy and physiology of the gastroesophageal junction

KAHRILAS P. J. ; SPECHLER Stuart Jon (Editeur scientifique)

Abstract
The gastroesophageal junction is a complex valve composed of a smooth muscle element (LES)
and a diaphragmatic element. These normally supplement each other to maintain competence in
a static condition and during dynamic stresses associated with increased intra-abdominal
pressure or swallowing. These sphincteric components also interact with each other
pathophysiologically. During swallowing, large hernias impair the process of esophageal
emptying, thereby prolonging acid clearance. The susceptibility to stress reflux inherent during
periods of diminished LES pressure is also dramatically increased by disabling the diaphragmatic
sphincter. These functional impairments of the gastroesophageal junction associated with hiatus
hemia lead to increased esophageal acid exposure and offer one explanation for the chronicity of
reflux disease.

Editor
Elsevier

Identifiant
ISSN : 0889-8553 CODEN : GCNAEF

Source
Gastroenterology clinics of North America A. 1997, vol. 26, n° 3, pp. 467-486 [22 pages] [bibl. :
47 ref.]

Titre du Document
Family history of cancer and stomach cancer risk
Auteur(s)
FOSCHI Roberto ; LUCENTEFORTE Ersilia ; BOSETTI Cristina ; ...
Résumé
A family history of stomach cancer in first-degree relatives increases the risk of stomach cancer,
but uncertainties remain as concerns the variation of the risk according to age, sex and type of
relative, as well as on the role of family history of other cancers. We investigated the issue using
data from a multicentric case-control study conducted in Italy between 1997 and 2007 on 230
cases aged not more than 80 years, with histologically confirmed incident gastric cancer and 547
controls admitted to hospital for acute, non neoplastic conditions. Logistic regression models
adjusted for the effect of sex, age, year of interview, education, body mass index (BMI), tobacco
smoking and number of brothers and sisters were used to estimate the odds ratios (OR) of
stomach cancer. Relative to subjects with no history, those with a family history of gastric cancer
had an OR of 2.5 (95% confidence interval (CI) 1.5-4.2). No significant heterogeneity emerged
according to sex or age of the proband or of the affected relative, or smoking habits, BMI and
education of the proband. As suggested from previous studies the OR was higher when the
affected relative was a sibling (OR =5.1, 95% CI: 1.3-20.6) rather than a parent (OR=2.2, 95%
CI: 1.2-3.9), although the heterogeneity test was not significant. The risk of stomach cancer was
not increased in subjects with a family history of cancer at any other site. The OR for all sites
excluding stomach was 1.0 (95% CI: 0.7-1.4).
Editeur
Wiley-Liss
Identifiant
PMID : 18567000 ISSN : 0020-7136 CODEN : IJCNAW
Source
International journal of cancer A. 2008, vol. 123, n° 6, pp. 1429-1432 [4 pages] [bibl. : 41 ref.]