Esophageal Acid Perfusion Test and a Gastroesophageal Reflux Test in Patients with Esophagitis

Abstract

Summary Two new procedures helpful in diagnosing esophagitis have been studied. The first is infusion of hydrochloric acid into the esophagus to attempt to reproduce the spontaneous symptoms. The second is detection of gastroesophageal acid regurgitation by simultaneous measurement of intraluminal pressure and pH. One hundred and twenty-four subjects studied by these two procedures revealed the following: 81 had clinical, endoscopic, or radiographic evidence of esophagitis. Of these, 64 responded positively to acid perfusion and manifested acid reflux; 2 showed symptoms on acid drip but no regurgitation; 15 failed to respond to acid perfusion but showed reflux. Forty-three patients were asymptomatic. Of these, 3 demonstrated esophageal acid regurgitation; the remainder responded negatively to both tests. Of 93.6 per cent of patients showing a zone of increased pressure in the area of the hiatus varying from 1 to 5 cm. in length, 3.2 per cent revealed, in addition, sustained elevation of intraesophageal above mean fundic pressure throughout the entire length of the esophagus, presumably due to esophageal spasm. These latter patients had symptoms referable to the esophagus, reacted to esophageal acid perfusion, and showed acid reflux. In all patients not manifesting diffuse increase of intraesophageal pressure, neither the height nor the length of the zone of increased pressure at the hiatus, nor the magnitude of the decrease between fundic and intrathoracic end-expiratory pressure was correlated with presence or absence of acid reflux. These findings show that gastroesophageal reflux occurs in most patients with esophagitis, and they support the hypothesis that this reflux plays a dominant role in the pathogenesis of the disease. Furthermore, both tests proved useful in differentiating esophagitis from other intrathoracic and intraabdominal diseases, especially angina pectoris and peptic ulcer. However, the mechanisms whereby gastric contents are normally prevented from entering the esophagus and the nature of the defect which permits such regurgitation remain obscure.