By Albert J. Bredenoord, André Smout, Jan Tack
This publication describes the motives and medical administration of sensible gastrointestinal issues in a with ease comprehensible manner, because of many transparent illustrations. The concrete and sensible recommendation supplied can be so much necessary within the scientific perform of either the final practitioner and the clinical professional. practical issues of the gastrointestinal tract, reminiscent of gastroesophageal reflux illness, useful dyspepsia, and irritable bowel syndrome, are quite common and protracted stipulations. regardless of the hot e-book of many medical papers on their prognosis and therapy, a lot continues to be uncertain, and administration continues to be thought of difficult. This practice-oriented booklet should be a great resource of trustworthy up to date tips for all who deal with those patients.
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Extra resources for A Guide to Gastrointestinal Motility Disorders
The nervous network of the myenteric plexus is found between the two muscle layers. The proximal one third of the esophageal muscles is striated, the middle third is a transition from striated to smooth muscle, and the distal third consists entirely of smooth muscle. The lower esophageal sphincter (LES) also consists of smooth muscle and can be regarded as a local specialization of the circular muscle layer. The LES is normally found at the level where the esophagus leaves the thorax and enters the abdomen through the diaphragmatic hiatus.
During swallowing the LES relaxes so the bolus can pass the sphincter and reach the stomach. After relaxation the sphincter contracts and returns to the tonic pressure of approximately 20 mmHg. A swallowed liquid bolus usually passes the esophagus in one swallow, for a solid bolus temporarily hold-up halfway in the esophagus is not uncommon and only after several swallows the bolus is cleared from the esophagus. 3 Belches With every swallow, some air is introduced into the esophagus. This air is transported to the stomach, together with the swallowed bolus.
In GERD patients a combination of both excessive reflux and hypersensitivity is often present. Reflux is considered excessive when there are more than 75 reflux episodes per day (50 acid reflux episodes per day) or when the esophagus is acidic (pH lower than 4) for more than 6 % of the time. These values are based on the upper limit of normal, measured as the 95th percentile in healthy subjects. The quantity of reflux is the resultant of the balance between defense against reflux and factors that promote reflux.
A Guide to Gastrointestinal Motility Disorders by Albert J. Bredenoord, André Smout, Jan Tack