Deglutitive pressure responses in the gastroesophageal sphineters of symptomatic hiatal hernia patients

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Resting pressures and pressure changes occurring with deglutition were recorded in each 0.5-cm. segment of the gastroesophageal sphincteric zone of 25 patients who had small, symptom-producing, sliding hiatal hernias. Pressures were detected by a water-filled balloon and laterally notched, water-filled polyethylene tubes attached to extracorporeal transducers and measured at end-expiration and end-inspiration. Mean maximal resting pressures in the sphincter were 10.5 cm. of water above gastric pressure (open-tip) and 21 cm. (balloon). With swallowing, a pressure decline below resting tone, indicating relaxation of subhiatal sphincteric segments, was often less pronounced than in health; slight increases occurred frequently. Contraction exceeded relaxation at the hiatus, a reverse of the findings in health. Contraction was most marked above the hiatus while relaxation became progressively less. Despite low resting sphincteric pressure (which probably predisposes to gastroesophageal reflux), impairment of the ability of the sphincter to relax, in addition to increases above resting tone in its subhiatal segments after deglutition, may produce an element of “functional obstruction” in some symptomatic hiatal hernia patients. Motor dysfunction of the body of the esophagus was frequent: 14 of the 25 patients studied exhibited severe or moderate derangements of contraction.