Document Detail

Lower esophageal sphincter pressure in patients with gastroesophageal reflux diseases and posture and time patterns.
MedLine Citation:
PMID:  15230730     Owner:  NLM     Status:  MEDLINE    
Gastroesophageal reflux disease is caused predominantly by lower esophageal sphincter insufficiency. Reports suggest that it is possible to distinguish between two main mechanisms causing reflux: low basal sphincter pressure leading to free reflux, mostly occurring at night in the supine position, and increased transient lower esophageal sphincter relaxations with normal or increased resting pressure leading to reflux during the day in an upright position. Lower esophageal sphincter pressure (LESP)-- s determined by stationary pull-through manometry--was compared to profiles of acidic reflux measured by 24-h pH monitoring in 207 patients with proven gastroesophageal reflux disease. Differences in LESP were not significant among patients with reflux predominantly during the day in an upright position and those with reflux predominantly at night in a supine position (16.1 +/- 7.4 mmHg versus 15.1 +/- 7.8 mmHg; t-test: P = 0.355). For both patterns of LESP, there was a slight negative correlation with the amount of acidic reflux (determined as a percentage of time with pH < 4). Pearson correlation coefficients were -0.196 for upright refluxers and -0.137 for bipositional/supine refluxers (P = 0.006 and P = 0.049, respectively). As there are no differences in LESP with regard to posture or time patterns of acidic reflux it seems unlikely that upright reflux is associated with increased LESP, whereas supine reflux manifests due to a hypotensive LESP. Alternatively, it may be concluded that stationary pull-through manometry is inadequate for determining the cause of gastroesophageal reflux disease and is therefore of limited use in its routine diagnosis.
A Meining; A Fackler; K Tzavella; M Storr; H D Allescher; A Klauser; W Heldwein
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus / I.S.D.E     Volume:  17     ISSN:  1120-8694     ISO Abbreviation:  Dis. Esophagus     Publication Date:  2004  
Date Detail:
Created Date:  2004-07-02     Completed Date:  2005-03-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8809160     Medline TA:  Dis Esophagus     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  155-8     Citation Subset:  IM    
Department of Medicine, Klinikum Innenstadt, University of Munich, Germany.
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MeSH Terms
Esophageal Sphincter, Lower / physiopathology*
Gastric Acidity Determination
Gastroesophageal Reflux / etiology*,  physiopathology*
Hydrogen-Ion Concentration
Middle Aged
Monitoring, Ambulatory
Posture / physiology*
Retrospective Studies
Time Factors

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