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Figure 6-12 A, Prevalence of gastric acid reflux, gastroduodenal reflux, and duodenal reflux into the esophagus and the probability of mucosal injury based on the monitoring of 100 consecutive patients with gastroesophageal reflux disease defined by an increased esophageal exposure to acid and/or bilirubin. B, Prevalence of reflux of gastric acid juice or gastric acid and duodenal juice in 100 patients with various degrees of esophageal mucosal injury. (From Fein, M., Ireland, A.P., Ritter, M.P., et al.: Duodenogastric reflux potentiates the injurious effects of gastroesophageal reflux. J. Gastrointest Surg., 1:27, 1997.)

Figure 6-13 A sample manometric measurement of the lower esophageal sphincter. The distances are measured from the nares. (RIP, respiratory inversion point.) (From Zaninotto, G., DeMeester, T.R., Schwizer, W., et al.: The lower esophageal sphincter in health and disease. Am. J. Surg., 155:105, 1988, with permission.)

Gastric Pressure

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