Movie Legends:
Video 1:- Endoluminal ultrasound of gastroesophageal junction in non-GERD subject
Video of endoluminal ultrasound of the gastroesophageal junction at the location of peak pressure in a subject without gastroesophageal reflux disease. The endoluminal ultrasound probe was held in place by taping it to the nose and video was recorded at 30 frames per second during 5 ml water swallow. The changes in the layers of the esophageal wall can be seen during the bolus transit at the high pressure zone of the gastroesophageal junction. The second hypo-echoic layer (from the ultrasound probe) containing the muscularis mucosa is thin in the beginning (Esophageal Squamous mucosa) but increases in thickness (Gastric Columnar Mucosa) as the bolus passes through. This occurs concurrently with an increase in the cross sectional area of the mucosa/submucosa demonstrating that the gastric mucosa moves into the tubular esophagus from the cardia of the stomach and partially obstructs the distal esophagus (mucosal plug). The second hypo-echoic layer returns back to a thin layer once the bolus is completely cleared, demonstrating that the gastric mucosa has left the tubular esophagus and the esophageal squamous mucosa has returned to the level of the ultrasound transducer.
Video 2:- Endoluminal ultrasound of gastroesophageal junction in GERD patient
Video of endoluminal ultrasound of the gastroesophageal junction at the location of peak pressure in a patient with gastroesophageal reflux disease. The endoluminal ultrasound probe was held in place by taping it to the nose and video was recorded at 30 frames per second during the 5 ml water swallow. The layers of the esophageal wall can be seen during the bolus transit at the high pressure zone of the gastroesophageal junction. The second hypo-echoic layer (from the ultrasound probe) containing the muscularis mucosa is thin through-out the duration of the bolus transit (Esophageal Squamous mucosa). There is little to no increase in thickness of this layer as the bolus passes through. This demonstrates that the gastric mucosa never moved up into the high pressure zone of the lower esophagus, which is contrary to the findings in normal control subjects.
Video3:- Abdominal ultrasound of Gastroesophageal junction in non-GERD subject
Video of abdominal ultrasound of the gastroesophageal junction showing the stomach and distal esophagus during 5 ml water swallow in a subject without gastroesophageal reflux disease. The video is recorded at 30 frames per second. The movement of different wall layers in the esophagus and the stomach are seen. It can be seen that the gastric mucosa is moving up into the tubular esophagus before the esophageal shortening due to contraction of the muscularis propria and before the bolus reaches the narrow part of the gastroesophageal junction. Once again, a functional obstruction of the tubular esophagus, a functional narrowing by the gastric mucosa within the tubular esophagus, is demonstrated. The bolus jets through this narrowed area into the stomach. The mucosa moves back into the stomach once the bolus is completely cleared from the esophagus.
Video4:- Abdominal ultrasound of Gastroesophageal junction in GERD patient
Video of abdominal ultrasound of the gastroesophageal junction showing the stomach and distal esophagus during 5 ml water swallow in a patient with gastroesophageal reflux disease. The video is recorded at 30 frames per second. Lack of movement of the different wall layers in the esophagus and the stomach are demonstrated. It can be seen that there is very little movement of the mucosa during swallowing as compared with the video of the normal control subject. The stomach contents are refluxing into the lower esophagus when the high-pressure zone of the distal esophagus relaxes at the initiation of swallow. This refluxed material is pushed back into the stomach along with the bolus.