Function of the Lower Oesophageal Sphincter in a Population Selected at Random A Manometric, Radiological, and Questionnaire study

Abstract

Using a manometric technique, incompetence of the lower oesophageal sphincter (LES) was found in eleven of forty persons selected at random. The women strongly predominated with respect to LES incompetence. The mean pressure difference between the LES and the distal part of the oesophagus at the end of expiration was 4.2 mmHg in the subjects with LES incompetence and 10.5 mmHg in the others. Six of those with LES incompetence were found to have hiatal hernia. Dys-motility of the oesophagus was common in the subjects with LES incompetence. On X-ray examination, one of the eleven subjects with LES incompetence was shown to have gastro-oesophageal reflux, and four were found to have hernia. All but one of the subjects with LES incompetence gave a history of symptoms suggesting reflux. The symptoms are graded on a scale. The difference in score between the competent and incompetent LES subjects is statistically highly significant (p < 0.001). The symptoms from organs other than the oesophagus innervated by the vagus nerve described by subjects with incompetent and competent LES are compared. The valve mechanism of the oesophagus sphincter is discussed.