Lower esophageal sphincter pressure as an index of gastroesophageal acid reflux

The purpose of this study was to determine the relationship of lower esophageal sphincter (LES) pressure and the volume of acid placed into the stomach required to induce gastroesophageal reflux in man. LES pressure was recorded continuously and by station pull-through by three radially oriented catheters in both symptomatic and asymptomatic subjects during the graded infusions of 0.1 N HCl acid into the stomach. Symptomatic subjects had a mean LES pressure of 7.5 +/- 0.7 mm Hg and refluxed at a volume of 140.0 +/- 21.0 ml. Fifty-five percent of asymptomatic subjects refluxed at a mean volume of 380.0 +/- 24.7 ml, and had a mean LES pressure of 13.8 +/- 0.4 mm Hg. Asymptomatic nonrefluxers at a volume of 500 ml of 0.1 N HCl acid had a mean LES pressure of 18.9 +/- 1.1 mm Hg. The mean LES pressure and acid volumes showed statistical significance between the three groups (P less than 0.01). There was an excellent overall correlation between LES pressure and acid volume required to produce reflux in all subjects (r = 0.91, P less than 0.001). Following reflux, asymptomatic but not symptomatic subjects showed a significance increase in LES pressure. These studies suggest that: (1) LES pressure does provide an accurate index of the gastroesophageal antireflux mechanism, provided that acid volume is considered; and (2) asymptomatic subjects showing acid reflux have higher LES pressures, reflux at higher volumes, and develop an LES contractile response after the reflux episode.