The Esophagogastric Junction Reconsidered.

Ninh T Nguyen, Peter J Kahrilas

Journal: Gastrointestinal endoscopy clinics of North America 2025;35(3):541-553

PMID: 40412989

Full Text on Elsevier Science View on PubMed

Abstract

The anti-reflux barrier at the esophagogastric junction (EGJ) has 3 functional components: (1) the lower esophageal sphincter, (2) the crural diaphragm, and (3) the gastroesophageal flap valve. Using endoscopic measures of length of hiatal herniation, dilatation of the hiatus, and presence of a flap valve, the American Foregut Society (AFS) Hiatus Grade stratifies EGJ integrity from normal (grade I) to increasing degrees of EGJ disruption (grade II-IV). The AFS classification stipulates endoscopic methodology to utilize in making the assessment and the AFS Hiatus Grade correlates well with EGJ anti-reflux barrier competence as gauged by prolonged recordings of esophageal pH-metry.

Address: Division of Gastroenterology, Hepatology, and Nutrition, Northwestern University, 676 North St Clair Street, 14th Floor, Chicago, IL 60611, USA. Electronic address: [email protected].; Department of Surgery, University of California Irvine Medical Center, Orange, CA, USA.

DOI: 10.1016/j.giec.2025.01.003

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MeSH Terms: Esophagogastric Junction, Humans, Gastroesophageal Reflux, Hernia, Hiatal, Esophageal Sphincter, Lower, Esophageal pH Monitoring