Ninety-three adult patients with benign esophageal stricture were randomized to receive balloon or bougie dilatation. Eighty-five patients were eligible for analysis and were followed prospectively for a year. Twenty-four patients required repeat dilatation within a year, but 50 patients completed a year's follow-up without further dilatation. The bougie group initially had a better symptomatic result, experiencing significantly less dysphagia at five months, although this difference had disappeared at one year. Eighteen patients in the balloon group required redilatation for symptoms compared with six in the bougie group. The bougie group had a significantly greater increase in their stricture diameter, and this was still present at one year after dilatation. There was no significant difference in safety or patient acceptability. Balloons are probably more costly to use than bougies. Bougie dilatation is to be preferred to balloon dilatation in adults except in special circumstances.

SUMMARY Seventy one patients with benign oesophageal strictures were randomised to receive balloon or bougie dilatation. Sixty five patients were eligible for analysis. At the end of five months the balloon group had significantly more dysphagia and the calibre of the strictures in the balloon group had narrowed by a greater degree. The methods were equally safe and acceptable to patients. While the choice of the method of dilatation depends on the individual patient's needs and operator experience, bougie dilatation is more effective in reducing dysphagia and maintaining stricture patency.Until the early 1980's, the main dilators in use for dilatation of benign oesophageal strictures at fibreoptic endoscopy in this country were the EderPuestow and Celestin dilators, or their modifications.' Although stricture dilatation using EderPuestow bougies has been practised for over 20 years2 there have been few controlled trials comparing the effectiveness of such 'traditional' dilators.3 A common feature of the dilators is that the forces exerted during dilatation are longitudinal and radial.In 1981 London described the first use of a modern balloon dilator.4 Balloons have since gained in popularity, possibly because of the theoretical appeal of applying a localised dilatating pressure in a controlled fashion, exerting only radial force on the stricture. Despite the increasing use of balloon dilators there has been no previous controlled comparison of balloons and traditional bougies.

SUMMARY A series of tests, including gastro-oesophageal sphincter pressure measurement, shortterm pH tests, and 15-hour overnight oesophageal pH recording were applied to 42 normal subjects and 214 patients with typical reflux symptoms. The results were compared by multivariate discriminant analysis. Sphincter pressure measurements misclassified 32%, stressed provocative manoeuvres 14-5 %, and the best single discriminator from the overnight pH study was time below pH 5, which misclassified 13 %. However, a combination of the number of reflux episodes in 15 hours with their mean duration reduced misclassification to 8-8 %. Using this function, a boundary between normal and refilux can be drawn, and the degree of abnormality can be expressed visually as well as numerically.This study was made to establish which of several specific diagnostic tests best matched the clinical diagnosis of gastro-oesophageal reflux (GOR) ina group of patients with characteristic 'reflux' symptoms, and to determine what correlation existed between different tests. Methods NORMAL SUBJECTSThere were 42 subjects (26 male, 16 female), aged 18 to 51 years (mean 32-8 years) with no symptoms of upper digestive tract disease. This group was composed of 26 volunteers and 16 subjects with the irritable bowel syndrome. The tests were explained and informed permission obtained. PATIENTSThere were 214 patients (116 male, 98 female) aged 17 years to 78 years (mean 47-2 years) with typical symptoms of GOR (heartburn and acid regurgitation related to posture and meals, and discomfort on drinking hot fluids). MANOMETRYIntraluminal pressure was measured with three polyvinyl catheters (1 2 mm ID) with a single side-hole, 5 cm apart. The catheters were continuously perfused with distilled water at 0-8 ml/min. With the patient supine the tips were withdrawn twice through

It is a common observation that stricture patients with severe dysphagia may have a wide lumen, while others with a narrow stricture have few swallowing complaints. In 64 patients with benign oesophageal stricture the dysphagia score (determined by questionnaire and by a test meal both based on nine different items of food scored according to their solidity) was compared with the diameter of the stricture measured radiologically by premeasured barium spheres. There was evidence of an association, but the correlation coefficient (r) was O0544(p=O00001), suggesting that the diameter of the stricture is an important, although not the sole, determinant of dysphagia. Stricture diameter explains 29-6% (r2) of variation in dysphagia score. The patients (mean dysphagia score 71 of a maximum possible 90) were divided into three groups according to the severity ofoesophagitis (19 patients had minimal, 22 moderate and 23 severe oesophagitis). Analysis revealed the mean dysphagia score to be 83,73,59 in each group respectively. Dysphagia score of each group was significantly different from the others (Kruskal-Wallis test). Relating the dysphagia score to stricture diameter for each group gives correlation coefficient r=0379 (p=OllO) in the minimal oesophagitis group, r=0-651 (p=0-001) in the moderate group, r=0 583 (p=0 004) in the severe group. If both diameter and severity of oesophagitis are included then 66-0% of the variation can be explained. It is concluded that the degree of oesophagitis is as important as luminal diameter in determining swallowing ability.

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