Abstract

The manometric characteristics of the lower esophageal high pressure zone (HPZ) in 15 young human subjects were studied with three continuously perfused side-opening recording catheters whose orifices were at an identical level and equidistant around the circumference of a circle. Withdrawal tracings were obtained during quiet respiration and with the breath held in inspiration and in expiration. With each type of tracing, there were marked differences between the three leads with respect to levels of entry into and exit from the HPZ, point of maximum pressure within the HPZ, maximum HPZ pressure, and point of respiratory reversal. A double respiratory reversal, in one lead only, was observed in 8 of the 15 subjects. Similar recordings for a given lead were obtained through each of the three transducers. These results indicate that the spatial orientation of the recording orifice has an important effect upon the type of tracing obtained from the HPZ. Further, they indicate that an incomplete and potentially misleading profile of the HPZ is obtained by standard recording techniques. The similarity of HPZ profiles recorded by a given lead in different subjects suggests that the observed difference between the three leads reflects an anatomical or physiological situation common to normal individuals. Several manometric features proposed for the diagnosis of hiatal hernia were observed frequently in this group of young, asymptomatic subjects. Hence, the diagnostic usefulness of these features is probably very limited.

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