Comparison of Lower Esophageal Sphincter Manometrics and Gastroesophageal Reflux Measured by 24-Hour pH Recording

Kraus, Barry B.; Wu, Wallace C.; Castell, Donald O.
June 1990
American Journal of Gastroenterology;Jun1990, Vol. 85 Issue 6, p692
Academic Journal
We compared lower esophageal sphincter (LES) pressures to parameters of acid reflux measured during 24-h pH monitoring in 81 patients being evaluated for possible reflux disease. Mid-respiratory LES pressures were significantly higher (p < 0.05) in patients with normal amounts of reflux than in those with abnormal reflux. This difference did not occur with LES pressure measured by end-expiratory station pull-through (SPT) or rapid pull-through (RPT). There was no significant difference in total length or intra-abdominal portion of LES between the two groups. However, the product of LES pressure and total LES length was greater (p < 0.05) for patients with normal reflux than for these with abnormal reflux. No difference was noted in the percentage of abnormal contractions in the distal esophagus between groups. These studies support the following conclusions: 1) LES pressure may be a more important protective mechanism against reflux than LES length. 2) Mid-respiratory SPT technique appears to identify the LES antireflux harrier better than either end-expiratory SPT or RPT techniques. 3) Acid exposure time seems to be a better measure of gastroesophageal reflux than the number of reflux episodes.


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