Relation between esophagogastric junction and esophageal function in patients with reflux esophagitis

The relationship between the esophagogastric junction (Z-line pattern) and the functions of the esophagus was studied in patients with reflux esophagitis. We classified Z-line patterns as the Z0- type to Z4-type, depending on the shape and the level of the Z-line. Lower esophageal sphincter pressure (LESP) was measured by the open-tip infusion method and the acid clearance test was performed by Booth's method (15 ml of 0.1 HCL). The following results were obtained: 1. LESP was 15.5 +/- 5.6 cmH2O (M +/- SD) in normal subjects (Z0-type), it was 10.3 +/- 2.9 cmH2O in the Z1-type, 9.5 +/- 4.9 cmH2O in the Z2-type, 9.4 +/- 4.1 cmH2O in the Z3-type and 7.6 +/- 3.4 cmH2O in the Z4-type. There were statistically significant differences between the Z0-type and the other Z-line patterns (p less than 0.05, P less than 0.05, P less than 0.025, and P less than 0.025, respectively). 2. Acid clearance was expressed as the time until the pH returned to 5.0 due to swallowing at one-minute intervals. The results of the acid clearance test were 11.4 +/- 3.0 min in the Z0-type 18.3 +/- 7.0 min in The Z1-type, 20.3 +/- 5.6 min in the Z2-type, 24.1 +/- 5.7 min in the Z3-type and 24.5 +/- 7.4 min in the Z4-type. Acid clearances were significantly delayed along with the Z-line pattern (P less than 0.025, P less than 0.005 and P less than 0.005, respectively). 3. The patients with hiatal hernia consisted of five cases of the Z3-type and six cases of Z4-type. They had low LESP and delayed acid clearance. As mentioned above, the results of LESP ad acid clearance test were well correlated with Z-line patterns in patients with reflux esophagitis.