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Abstract
Gastro-esophageal reflux disease is the commonest upper digestive disorder with approximately 45% of the population having reflux symptom. It affects a large group of patients and has a negative impact on quality of life. In addition, this disorder is associated with considerable long-term morbidity and mortality.Symptoms of GERD include retrosternal burning and regurgitation, which are highly predictive of acid exposure to the esophageal mucosa (Shimi SM, 2002).
The passage of food from the esophagus to the stomach is facilitated by a transient relaxation of the distal esophagus. It is initiated by swallowing-induced peristaltic waves. The resting tone of the distal esophagus is important in preventing the reflux of gastric contents into the thoracic portion of the eso-phagus. The anatomic area integral to the prevention of reflux is the abdominal esophagus, where the high-pressure zone (HPZ) is located. The HPZ is dependent on many factors, including an adequate length of intra-abdominal esophagus, intact phreno-esophageal ligaments, normal diaphragm, and sufficient gastric emptying. Symptoms of reflux tend to occur when the sphincter pressure is (0-5mmHg). About 81% of patients in whom the intra-abdominal esophagus is 1cm or shorter have reflux, whereas 38% of those with an intra-abdominal segment longer than 3cm have reflux (Winan and Harris, 2002