# Hiatal Dysfunction in Achalasia Esophagus

> **NIH NIH R56** · UNIVERSITY OF CALIFORNIA, SAN DIEGO · 2021 · $663,222

## Abstract

Project Summary: The sphincter mechanism at the lower end of the esophagus, lower esophageal sphincter
plays a major role in the pathophysiology of esophageal motor disorders. An incompetent sphincter leads to
reflux disease (weak sphincter or too much relaxation) and overtly competent sphincter (too little relaxation)
leads to achalasia esophagus and possibly other motor disorders of the esophagus. Exact understanding of
the lower esophageal sphincter has defied generations of investigators. Our studies, over a span of more than
35 years have revealed that the lower esophageal sphincter mechanism consists of 2 components, smooth
muscle LES and skeletal muscle crural diaphragm (CD). Using “state of the art” techniques such as 3D-high
resolution manometry along with static and dynamic CT scan imaging, our preliminary studies suggests that
the crural diaphragm which forms the esophageal hiatus may play a crucial role in the pathogenesis of
achalasia esophagus, a major motility disorder of the esophagus. The specific goals of the proposal are to
define: 1) the 3D pressure profile of the EGJ in achalasia esophagus: extend our preliminary findings of
anatomical and functional abnormalities of crural diaphragm in patients with achalasia esophagus, to study the
crural diaphragm structure and function using MR imaging and crural diaphragm EMG recordings respectively.
2) To demonstrate lack of sliding, or in other words a tight anchoring between the LES and crural diaphragm in
patients with achalasia esophagus. 3) We propose to study the effect of spine disc injury on the structure and
function of the crus of diaphragm/hiatal muscle in an animal model: We will test a novel hypothesis that injury
to the lumbar spine leads to pathological changes in the structure and function of the crus diaphragm muscle.

## Key facts

- **NIH application ID:** 10421810
- **Project number:** 1R56DK129451-01
- **Recipient organization:** UNIVERSITY OF CALIFORNIA, SAN DIEGO
- **Principal Investigator:** RAVINDER K. MITTAL
- **Activity code:** R56 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $663,222
- **Award type:** 1
- **Project period:** 2021-08-01 → 2023-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10421810

## Citation

> US National Institutes of Health, RePORTER application 10421810, Hiatal Dysfunction in Achalasia Esophagus (1R56DK129451-01). Retrieved via AI Analytics 2026-06-01 from https://api.ai-analytics.org/grant/nih/10421810. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*