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After a careful clinical investigation (anamnesis, analysis of stomach secretion, X-ray tests, esophagoscopy with biopsies) of 45 patients with axial hiatus hernia and 20 healthy volunteers with no radiological signs of reflux, manometric analysis of the lower esophageal sphincter (LES) was performed. The manometric tests applied were: (1) 3-point manometry for measuring the reflexive pressure increase in the LES after abdominal compression and (2) the continuous withdrawal method before and after intravenous injection of 0.6 µg/kg pentagastrin (LES pentagastrin test). According to the results obtained by all methods applied, the patients with hiatus hernia could be divided into two groups. Group I consists of 12 patients with moderate clinical symptoms and essentially normal pressures and reactions of the LES. Group II comprises 33 patients with more severe symptomatology such as X-ray evidence of reflux (33), stenosis (3) or esophagitis of the lower esophagus (17), hyperacidity of the stomach (5), insufficient reaction of the LES to abdominal compression (29), reduced maximum pressure in the LES and an abnormally low response of the LES to intravenous pentagastrin (19). Essentially by means of the results of the LES pentagastrin test, group II could by subdivided into group IIA, with a normal, and group IIB with significantly reduced pentagastrin response. There was a good correlation between the reduced pentagastrin response and the exhibition of more severe symptoms of the other parameters tested. Thus, it could be shown that the LES-pentagastrin test could contribute to a further differentiation, which is important in respect to the therapeutic consequences and assist in a better understanding of the pathophysiological basis of the disease.

In investigations with various groups of patients there was no correlation between fasting serum IRG levels and LES pressures in individual subjects with undisturbed or disturbed sphincters. After food ingestion a short phase of LES pressure increase (from 13.5 ± 1.5 to 21.7 ± 3.8 mm Hg) could be observed. This peak occurs during the phase of rise in gastrin level, but there was no correlation between IRG levels and LES pressure in individual cases. In patients with gastroesophageal reflux we can demonstrate a diminished release of gastrin after a test meal, but there was also a diminished capacity of the LES. In conclusion, in this investigation it has not been possible to show a clear connection in humans between serum IRG and LES function.

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