The Continuous Withdrawal Method for the Quantitative Analysis of the Lower Oesophageal Sphincter (LES) in Humans

Abstract

Abstract. 1. The continuous withdrawal method which has been used successfully in animal experiments for recording pressure profiles in the lower oesophageal sphincter, LES, was applied for the first time in human studies. A catheter with 4 side holes which served as a pressure transmitter, was continuously withdrawn from the stomach at a constant speed (6 mm/sec.) while constantly perfused (5 ml/min.). This procedure shows numerous advantages, particularly for quantitative analysis, when compared to both the stepwise pull‐through method and an open‐side catheter lying stationary in the sphincter. Thus the profiles obtained using the continuous withdrawal method are remarkable for their definition. Displacements, which can occur with a stationary catheter, are eliminated, and the pressure maximum can be definitely determined even if there is a shift in the area of maximum pressure. – 2. Pressure profiles of the LES taken with the withdrawal method in 20 conscious subjects usually showed a gradual, and then more rapid increase from aboral to oral, which after reaching a maximum value decreased steeply and changed into sub‐zero pressures. The maximum pressure taken from the pressure profiles of 20 subjects, being the mean value of all experiments, was 19 ± 7.3 mm Hg with a mean sphincter length of 3.4 ±0.6 cm (x̄±SD). The pressure profiles could be recorded at short intervals (0.5‐2 min.) without appreciable irritation of the sphincter. – 3. The continuous withdrawal method proved especially efficient, even after an increase of the sphincter tone induced by Pentagastrin (0.6 μg/kg I. V.). The mean results of the experiments in 6 test subjects showed that the maximum pressure in the LES increased from 13 ± 6.3 mm Hg to 44.2 ± 11 mm Hg 1 min. after the injection and the mean sphincter length increased from 3.9 ±1.2 cm to 5.3±1.4cm. These effects had subsided after 7–10 min. Pressure profiles obtained in this way, as well as supplementary measurements, indicated that Pentagastrin can cause a shift of the maximum pressure area in the oral direction.

The minimum pressure of the lower esophageal sphincter, determined by the rapid pull-through method, is an index of severe reflux esophagitis

“…Basal LES pressure measurement could not predict function in individual patients, except in those subjects who had a very low LES pressure. The rapid pull-through method is an established procedure for measuring LES pressure, 3,4 and it was used in the present study. The LES has radial asymmetry with maximum pressure on the left side.…”

The Relationship between Serum IRG Levels and LES Pressure under Various Conditions

“…For measuring the pressure or changes of pressure in the lower esophageal sphincter we used the rapid pull through technique (31). In this technique a continuously perfused catheter (diameter 4 mm) was pulled at a constant speed from the stomach through the LES into the esophagus and the pressure registered on a scriptor.…”

Antroduodenal Manometry in Children and Adults with Severe Nonulcer Dyspepsia

“…The mean lower esophageal sphincter (LES) basal pressure was assessed by the slow pull-through method (18). In our laboratory the lower limit of normal LES pressure is 15 mm Hg in both adults and children.…”