ESOPHAGEAL MOTOR ABNORMALITIES INDUCED BY ACID PERFUSION IN PATIENTS WITH HEARTBURN*

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Abstract
A study was per-formed correlating clinical, endoscopic, histologic, and acid-perfusion studies with intraluminal manometric recording in 25 patients with heartburn, who, from their histories, were thought to have esophagitis. Histologic evidence of inflammation was found in only 18 of the 25. These patients were compared with a group of 25 patients with no esophageal symptoms. Acid perfusion produced substernal pain in all the patients in the heartburn group but in none of the controls. Motor abnormalities were observed in all patients in whom acid perfusion reproduced symptoms, suggesting that disordered motor function plays a role in the production of these esophageal symptoms. From these studies it is evident that the symptom of heartburn correlates more closely with reactivity of the esophagus to perfused acid than to the presence of inflammation. The common denominator in these patients is an esophagus which, due to an as yet unknown mechanism, is unduly reactive to refluxed gastric contents. This abnormal reactivity is manifested by heartburn and concomitant esophageal motor abnormalities.