Abstract
THE RELATION OF LOWER ESOPHAGBAL SPHINCTER PRESSURE ASYMMETRY TO SPHINCTER COMPETENCY IN PATIENTS WITH ESOPHAGITIS AND GASTROESOPHAGEAL REFLUX. R.W. Welch, P.M. Ricks, L.C. Owensby and B. Schelper, Department of Medicine, The University of Texas Health Science Center. San Antonio. Texas. Cor 2) 13 patients with gastroesophageal reflux and esophagitis (GER + E) proven by suction biopsy; and 3) 7 patients with gastroesophageal reflux but 0 histologic esophagitis (GER ONLY). In all three groups LESP was measured sequentially using the motorized pull-through method (l/2 cm/set) with a perfused 8 lumen, radially-oriented probe. SART was then immediately performed. SART was .3 + .1 (?? f 1 SEM) in the 18 normals, 8.1 t 2.8 in the GER + E group, and 6.1 + 1.9 in the GER ONLY group. Both symptoms and SART scores were statistically similar in the two groups of refluxers. In the normal subjects there was a consistent leftward bulge of pressure almost twice that of rightward (44 vs 23mmHg). The 13 patients with GER + E maintained the leftward pressure bulge but all radially-oriented sphincter pressures were reduced, particularly in the rightward direction where pressure was 9 ? .7. In all other directions LESP in GER + E overlapped statistically with the normal controls. In the 7 patients with GER ONLY, LESP's were virtually identical with the normal group, despite the fact that these patients had proven gastroesophageal reflux as severe as those with esophagitis. We conclude that LESP asymmetry persists in gastroesophageal reflux, with or without esophagitis. Radially-oriented rightward LESP measurements are helpful in distinguishing patients with histologic esophagitis. Patients with GER ONLY cannot be distinguished from normal by LESP measurement. LESP hypotension appears to be a consequence of esophagitis and not a cause.
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