Esophageal Motor Abnormalities Induced by Acid Perfusion in Patients With Heartburn*

Abstract

The clinical diagnosis of esophagitis is suggested by the presence of severe heartburn which is aggravated by the recumbent position. The symptom is generally worse after eating and is relieved by antacids. It is generally held that increased reflux of gastric contents leads to the development of esophagitis and that the pain is associated with an inflammatory process. In many patients with symptoms that suggest a diagnosis of esophagitis, however, there is, no endoscopic or histologic evidence of inflammation. The poor correlation between the clinical diagnosis of esophagitis and the endoscopic and histologic observations led to an investigation of esophageal motor function in these patients. METHOD AND MATERIALSTwenty-five patients with the clinical diagnosis of esophagitis were studied. The clinical diagnosis was based on the following criteria: recurrent burning retrosternal pain, which was more severe after eating, aggravated by the recumbent position, and improved by antacids. Esophagoscopy was performed in all patients. Specific features noted were mucosal reddening, granularity, erosion, ulceration, stricture, and the presence and degree of gastroesophageal reflux. Esophageal biopsies were obtained from an involved area if gross changes were observed and from the distal 4 cm of esophagus when no endoscopic abnormalities were present. X rays of the upper gastrointestinal tract with special attention to the gastroesophageal junction were obtained in all patients. Radiographic evidence of hiatus hernia and esophageal reflux was sought with the patients in the Trendelenburg position. Acid perfusion of the lower esophagus, with the technique to be described, was performed on all patients.These patients were compared with a control group of 25 patients who had none of the criteria described above for the clinical diagnosis of esophagitis. The control group, some of whom had coronary artery disease, were *This investigation was supported by U. S. Public Health Service research grant A-1687(C4) and U. S. Public Health Service training grant 2A-5095(C4).t John and Mary R. Markle Scholar. not all esophagoscoped, but acid-perfusion studies and radiologic studies were performed in all. A tabulated description of the heartburn and the control groups is found in Tables I and II. Pathologic findings and motility records were graded without knowledge of the clinical or endoscopic findings. On the other hand, the esophagoscopist was usually under the impression that the clinical diagnosis was esophagitis.Esophageal motor studies were performed with the subj ect supine. Three open-tipped, water-filled polyvinyl catheters with the tips placed 5 cm apart were introduced into the stomach. The catheters were connected to external transducers that were leveled at the posterior axillary line, and simultaneous, four-channel, direct-writing recording was performed.' The catheters were withdrawn into the esophagus in 1-cm steps to measure the resting tone of the lower esophageal sphincter. After the resting pressure of the lower e...

The Globus Symptom

“…Previous studies have shown that acid perfusion of the pathological oesophagus reproduces the symptoms of reflux oesophagitis and is a re liable diagnostic method for differentiating cardiac from oesophageal symptoms [Bernstein and Baker, 1958;Bernstein et al, 1962], Manometric evidence of disturbed oesophageal motility has also been obtained following acid perfusion of the oesophagus in patients with reflux oeso phagitis [Tuttle et al, 1960;Siegel and H endrix, 1963], A simplifica tion of the examination technique was achieved by the introduction of acid barium, with subsequent roentgenological evaluation of oeso phageal motility patterns [Hookman et al, 1965;Donner et al, 1966].…”

Intraluminal pH and Oesophageal Motility in Patients with Gastro-Oesophageal Reflux

“…Tuttle et al [7] could not detect any alterations in oesophageal motor activi ty, whereas according to Siegel and Hendrix [8], intra-oesophageal acid perfusion induced motor abnormalities while reproducing the symptoms. In the present study, the oesopha geal motor response to intraluminal disten sion was investigated, and the volume in fused has been considered equivalent to the volume which induced the oesophageal con traction.…”

Oesophageal pain

“…Of Siegel & Hendrix (1963): is that muscular contractions of the oesophagus cause the pain; Tuttle's group in Los Angeles believe that chemical irritation is the basis of heartburn (Tuttle, Bettarello & Grossman, 1961).…”