Lower esophageal sphincter pressure in histologic esophagitis.

The fasting lower esophageal sphincter pressure of 18 normal volunteers was compared to 22 patients with symptoms and objective evidence of gastroesophageal reflux. Lower esophageal sphincter pressure was measured by rapid pull-through using an 8-lumen radially perfused catheter that sampled pressure every45 degrees around the circumference of the sphincter. The 22 reflux patients were subdivided for analysis into two groups, those with an acute inflammatory infiltrate on biopsy and those without inflammation. Those patients without inflammatory esophagitis had normal sphincter pressures. Those with a definite inflammatory infiltrate had pressures significantly less than normal. The least reliable separation between normals and those with inflammatory esophagitis occurred in the anterior orientations. We conclude that while basal lower esophageal sphincter pressure measurement may identify patients with reflux and inflammatory esophagitis, it is of no help in identifying those patients with reflux unassociated with inflammation. Decreased basal fasting LESP does not appear to be the most important primary determinant of gastroesophageal reflux.

Change in the force-summed pressure measurements of the upper esophageal sphincter prelaryngectomy and postlaryngectomy.

The pharyngoesophageal high pressure zone (PE-HPZ) was measured prelaryngectomy and postlaryngectomy with a new force-summing probe that accounts for sphincter pressure asymmetry. A total of 31 patients were studied six times each. Postoperatively, pressures dropped from 130+/-24 mm Hg to 66+/-9 mm Hg. After a standardized, intensive laryngectomy rehabilitation program, 12 of 19 postoperative patients acquired acceptable esophageal speech and 7 did not. Speakers and nonspeakers were found to have nearly identical PE-HPZ pressures (speakers = 70+/-10 mm Hg, nonspeakers = 59+/-18 mm Hg). Differences in sphincter length or relaxation likewise did not discriminate between these two groups. We conclude that PE-HPZ pressure is not a critical determinant of the acquisition of esophageal speech.

Manometry of the normal upper esophageal sphincter and its alterations in laryngectomy.

Rapid pull-through pressure profiles of the normal human upper esophageal sphincter (UES) were simultaneously studied with a conventional three-orifice Honeywell solid-state probe, an eight lumen radially perfused (RP) probe, and a circumferentially sensitive (CS) probe designed to measure UES pressure (UESP) without regard to probe orientation. Pressure curves were digitized and analyzed by computer. The Honeywell probe recorded significantly lower peak pressures than the other two methods, and had wide intrasubject pressure variations (average coefficient of variation, 53%). In contrast, UESP measured with the CS probe was constant for each subject (mean peak UESP, 121 mm Hg; average coefficient of variation, 15%). Anteroposterior RP probe UESP were identical to CS probe pressures. Thus, peak perfused anteroposterior UESP correlates with circumferentially measured sphincter squeeze.Computer programs were written that allowed RP probe pressures to be mapped in three dimensions. Normal three-dimensional maps were characterized by anteroposterior accentuation of peak pressures and also by consistent axial asymmetry with anterior peak pressures occurring 0.8+/-0.2 cm closer to the pharynx. After defining the normal two- and three-dimensional UESP configuration, patients who had undergone laryngectomy were studied. Peak pressures measured with the RP probe decreased to congruent with50 mm Hg and radial pressure asymmetry vanished. Like normals, CS probe pressures corresponded to peak RP probe pressures. UES length did not change significantly. Three-dimensional mapping showed that axial asymmetry also vanished. It therefore appears that the anatomic alterations produced by laryngectomy abolishes UESP asymmetry.