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The lower esophageal sphincter as a barrier to gastro esophageal reflux

Gastroenterology 72(1): 19-22
The lower esophageal sphincter as a barrier to gastro esophageal reflux
To correlate lower esophageal sphincter (LES) pressure and gastroesophageal (GE) reflux, esophageal manometry and GE scintiscanning were used to study 40 consecutive patients. Serial scintiscanning was performed as the GE pressure gradient was increased in increments. Reflux was calculated from the ratio of esophageal to gastric radioactivity. The relationship between GE reflux and LES pressure was inverse (r = -0.60, P < 0.005). Two subgroups of 10 patients were studied further. After atropine LES pressure decreased from 11.2 .+-. 1.1 to 5.3 .+-. 0.9 mm Hg (P < 0.01) at 20 min. The GE reflux index increased from 8.3 .+-. 2.1 to 13.4 .+-. 2.2% (P < .05). After bethanechol LES pressure increased from 8.9 .+-. 0.8 to 18.5 .+-. 1.0 mm Hg (P < 0.001) at 30 min. GE reflux decreased from 11.9 .+-. 2.4 to 5.8 .+-. 1.7% (P < 0.01). GE reflux correlated with basal LES pressure by an inverse relationship; atropine decreased LES pressure and increased reflux. Bethanechol increased LES pressure and decreased reflux. LES pressure was an important determinant of GE competence.

Accession: 006712288

PMID: 830232

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