Diagnosis of Gastroesophageal Reflux Disease Using Real-time Magnetic Resonance Imaging

A small angle (His angle) between the oesophagus and the fundus of the stomach is considered to act as flap valve and anti-reflux barrier. A wide angle results in dysfunction of the oesophagogastric junction and subsequently in gastroesophageal reflux disease (GERD). Here, we used real-time magnetic resonance imaging (MRI) at 50 ms resolution (20 frames per second) in 12 volunteers and 12 patients with GERD to assess transport of pineapple juice through the oesophagogastric junction and reflux during Valsalva. We found that the intra-abdominal part of the oesophagus was bended towards the left side resulting in an angle of 75.3 ± 17.4, which was significantly larger during Valsava (P = 0.017). Reflux and several underlying pathologies were detected in 11 out of 12 patients. Our data visualize oesophagogastric junction physiology and disprove the flap valve hypothesis. Further, non-invasive real-time MRI has considerable potential for the diagnosis of causative pathologies leading to GERD.

[1]  Zhigang Wang,et al.  Meta‐analysis of laparoscopic total (Nissen) versus posterior (Toupet) fundoplication for gastro‐oesophageal reflux disease based on randomized clinical trials , 2011, ANZ journal of surgery.

[2]  Jens Frahm,et al.  Real‐time MRI at a resolution of 20 ms , 2010, NMR in biomedicine.

[3]  Jens Frahm,et al.  Real-time cardiovascular magnetic resonance at high temporal resolution: radial FLASH with nonlinear inverse reconstruction , 2010, Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance.

[4]  M. Hoshino,et al.  Role of the lower esophageal sphincter on acid exposure revisited with high-resolution manometry. , 2011, Journal of the American College of Surgeons.

[5]  H. Gooszen,et al.  Systematic review and meta‐analysis of laparoscopic Nissen (posterior total) versus Toupet (posterior partial) fundoplication for gastro‐oesophageal reflux disease , 2010, The British journal of surgery.

[6]  A. Bredenoord,et al.  Determinants of perception of heartburn and regurgitation , 2005, Gut.

[7]  Martin Uecker,et al.  A Multi-GPU Programming Library for Real-Time Applications , 2012, ICA3PP.

[8]  D. F. Rochester,et al.  Electrical and mechanical activity in the human lower esophageal sphincter during diaphragmatic contraction. , 1988, The Journal of clinical investigation.

[9]  J. Pandolfino,et al.  High-Resolution Manometry of the EGJ: An Analysis of Crural Diaphragm Function in GERD , 2007, The American Journal of Gastroenterology.

[10]  Jens Frahm,et al.  Real-time magnetic resonance imaging of cardiac function and flow-recent progress. , 2014, Quantitative imaging in medicine and surgery.

[11]  J. Heidelbaugh,et al.  Management of gastroesophageal reflux disease. , 2003, American family physician.

[12]  Jens Frahm,et al.  Real-time MRI: recent advances using radial FLASH. , 2012 .

[13]  Jens Frahm,et al.  Advances in real‐time phase‐contrast flow MRI using asymmetric radial gradient echoes , 2016, Magnetic resonance in medicine.

[14]  J. Wilson,et al.  Functional esophageal disorders , 1999, Gut.

[15]  Jens Frahm,et al.  High-speed real-time magnetic resonance imaging of fast tongue movements in elite horn players. , 2015, Quantitative imaging in medicine and surgery.

[16]  R. Nissen.  [A simple operation for control of reflux esophagitis]. , 1956, Schweizerische medizinische Wochenschrift.

[17]  Jens Frahm,et al.  Real‐time magnetic resonance imaging of normal swallowing , 2012, Journal of magnetic resonance imaging : JMRI.

[18]  J. Dent,et al.  Epidemiology of gastro-oesophageal reflux disease: a systematic review , 2005, Gut.

[19]  Jens Frahm,et al.  Real‐time phase‐contrast MRI of cardiovascular blood flow using undersampled radial fast low‐angle shot and nonlinear inverse reconstruction , 2012, NMR in biomedicine.

[20]  Jens Frahm,et al.  Real‐time MRI of speaking at a resolution of 33 ms: Undersampled radial FLASH with nonlinear inverse reconstruction , 2013, Magnetic resonance in medicine.

[21]  D. Colin-Jones,et al.  Oesophageal motor function before and after healing of oesophagitis. , 1992, Gut.

[22]  Arun A. Joseph,et al.  Real-time phase-contrast flow MRI of the ascending aorta and superior vena cava as a function of intrathoracic pressure (Valsalva manoeuvre). , 2014, The British journal of radiology.

[23]  W. Orr,et al.  Review article: sleep‐related gastro‐oesophageal reflux as a distinct clinical entity , 2010, Alimentary pharmacology & therapeutics.

[24]  R. Heading,et al.  Lowered oesophageal sensory thresholds in patients with symptomatic but not excess gastro-oesophageal reflux: evidence for a spectrum of visceral sensitivity in GORD. , 1995, Gut.

[25]  Jens Frahm,et al.  Real‐time flow MRI of the aorta at a resolution of 40 msec , 2014, Journal of magnetic resonance imaging : JMRI.

[26]  Jens Frahm,et al.  Real-time cardiovascular magnetic resonance at 1.5 T using balanced SSFP and 40 ms resolution , 2013, Journal of Cardiovascular Magnetic Resonance.

[27]  R. Kozarek,et al.  The gastroesophageal flap valve: in vitro and in vivo observations. , 1996, Gastrointestinal endoscopy.

[28]  P J Kahrilas,et al.  Esophageal peristaltic dysfunction in peptic esophagitis. , 1986, Gastroenterology.