Peiweng Chen MD, Presenter: Nothing to Disclose

Michael Lyon Loftus MD, MBA, Abstract Co-Author: Nothing to Disclose

Katharine Lampen-Sachar MD, Abstract Co-Author: Nothing to Disclose

Neil Pravin Shah MD, Abstract Co-Author: Nothing to Disclose

Marc Zachary Simmons MD, Abstract Co-Author: Nothing to Disclose

Robert Andrew Lefkowitz MD, Abstract Co-Author: Nothing to Disclose

Alexander R. Margulis MD, Abstract Co-Author: Nothing to Disclose

Marc Jeffrey Gollub MD, Abstract Co-Author: Nothing to Disclose

00030490-DMT et al, Abstract Co-Author: Nothing to Disclose

The importance of our alimentary sphincters is vastly underappreciated. We will review normal function, dysfunction and diseases of our 5 alimentary sphincters  

Using multimodality imaging including barium fluoroscopy, CT, MR, videofluoroscopy, dynamic MRI, endoluminal ultrasound and 18F-FDG PET the normal radiographic and anatomic appearance will be illustrated. A discussion of normal function and abnormal muscular conditions will be detailed. Various developmental and acquired benign and malignant conditions and their sequelae will be documented with imaging and brief explanations. The clinical importance and keys to diagnosis will be stressed throughout.

The upper esophageal sphincter ([UES], cricopharyngeus), Lower esophageal sphincter ([LES], A ring), pylorus, ileocecal valve/sphincter (ICV) and anal sphincter complex (internal and external anal sphincter, [ASC]) allow us to acquire our necessary nutrition without losing continence, being aerophagic, having bile acid reflux and GERD while we breathe comfortably and avoid aspiration pneumonia. The normal function of these sphincters is poorly understood. Their normal and abnormal imaging appearances are frequently misinterpreted. Such entitites as chalasia, achalasia, cricopharyngeal malfunction, herniae, rings, Sievert-type adenocarcinomas, hypertrophic pyloric stenosis, channel ulcers, double pyloric channels and peri-pyloric malignancies will be detailed. The functional and surgical importance of the ICV and the myriad and the complex anatomy and  function of the ASC, incontinence and dynamic studies of this region will be shown as well as the important imaging criteria and surgical options when recto-anal cancers are found.

An understanding of the 5 sphincters of the alimentary tract that allow us to gain nutrition and maintain continence is essential for the radiologist involved in interpreting radiologic studies of the neck, chest, abdomen and pelvis. A better appreciation of the normal function and spectrum of diseases that can affect these important junctions will prevent over- or misinterpretation and will improve our accuracy when questions arise, as they so often do.

This poster will re-educate radiologists and clarify the appearances and the many confusing aspects of normal function, dysfunction and disease involving the 5 alimentary tract sphincters.

Chen, P, Loftus, M, Lampen-Sachar, K, Shah, N, Simmons, M, Lefkowitz, R, Margulis, A, Gollub, M, et al, 0, GI Sphincterology: Your Inner Strength Rings True.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8005517.html