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The esophagogastric junction (EGJ) is located at the distal end of theesophagus and acts as a valve allowing swallowed materials to enter the stomachand preventing acid reflux. Irregular weakening or stiffening of the EGJmuscles result in changes to its opening and closing patterns which canprogress into esophageal disorders. Therefore, understanding the physics behindthe opening and closing cycle of the EGJ provides a mechanistic insight intoits function and can help identify the underlying conditions that cause itsdegradation. Using clinical FLIP data, we plotted the pressure-area hysteresisat the EGJ location and distinguished two major loop types, a pressure dominantloop (PDL) and a tone dominant loop (TDL). In this study, we aimed to identifythe key characteristics that define each loop type and find what causes theinversion from one loop to another. To do so, the clinical observations werereproduced using 1D simulations of flow inside a FLIP device located in theesophagus, and the work done by the EGJ wall over time was calculated. Thiswork was decomposed into active and passive components, which revealed thecompeting mechanisms that dictate the loop type. These mechanisms are esophagusstiffness, fluid viscosity, and the EGJ relaxation pattern. In PDL, the leadingsource of energy in the cycle is coming from the fluid pressure increase fromthe peristaltic contraction wave, and in TDL the leading source of energy inthe cycle is coming from the contraction and relaxation of the EGJ tone.

Pressure -- area loop based phenotypic classification and mechanics of esophagogastric junction physiology