Lower Esophageal Sphincter Pressure in Normal Individuals and Patients with Gastroesophageal Reflux

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Abstract
The advantage of a single-lumen end-hole catheter compared with the usual composite side-hole catheter for lower esophageal sphincter (LES) manometry has been studied in vitro and in vivo. In the present study LES pull-through manometry was performed with a special catheter, enabling simultaneous end-hole and side-hole recording of LES pressure. Eighteen normal individuals with normal 24-h pH-monitoring (control group) and 42 reflux patients with pathologic 24-h pH-monitoring (reflux group) were studied. End-hole recorded resting sphincter pressure (RSP) in the control group was 15.4 .+-. 5.0 cm H2O and in the reflux group 6.4 .+-. 6.4 (p < 0.0005). Side-hole recorded RSP (mean S1-S3) was 20.8 .+-. 11.6 and 11.9 .+-. 6.8, respectively (p < 0.005). End-hole recorded total sphincter length (SL) in the control group was 34 .+-. 9 mm and in the reflux group 27 .+-. 12 (p < 0.025) and abdominal sphincter length (ASL) 23 .+-. 7 and 16 .+-. 9, respectively (p < 0.005). Side-hole recorded SL was 30 .+-. 7 and 30 .+-. 12, respectively (NS) and ASL 22 .+-. 6 and 18 .+-. 9 respectively (NS). After intake of 500 ml of water both LES pressure and length decreased in both groups but the separation between the groups was neither improved nor impaired. The results support the view that LES insufficiency is an important cause of gastroesophageal reflux. That LES had a lower pressure and was shorter in patients with reflux was best demonstrated by end-hole recorded pressure.