Etiology (Reflux)

haem_1a_n.jpg: Simplified drawing of the structures which enable a normal mechanism of closure of the gastroesophageal transition zone already shortly after birth or following maturation during infancy. An acute angle between the inflow tract consisting of the abdominal esophagus and the fundus is lying in front = the normal angle of His is a sign for it !£haem_1a_p£!. On the left side there is a tight connection between the back of the esophagus and the diaphragm which is probably one of the important structures responsible for a normal gastroesophageal closure mechanism. Other important structures are the arrangement and the course of the muscle fibers leading from the esophagus into the stomach. Notice the low-situated normal fold of the peritoneum. haem_1b_n.jpg: A missing or obtuse angle of His and parts of fundus above the diaphragm are visible. The peritoneal fold which is demonstrated in front and behind has a very high position in contrast to haem_1a_n.jpg. A tight connection between diaphragm and back of the esophagus is missing or has not developed during infancy; therefore, the relation of the esophagus to the stomach and of these structures to the diaphragm diverge to a different degree from normality, resulting in a gastroesophageal reflux with or without hiatus hernia. In the drawing an extreme variation of the explained anomaly is depicted, combined with the presence of a hiatus hernia (M. Bettex).