Lower esophageal sphincter in reflux esophagitis

Area of Science:

• Gastroenterology
• Physiology

Background:

• Gastroesophageal reflux disease (GERD) is often associated with impaired lower esophageal sphincter (LES) function.
• Understanding the specific pressure dynamics of the LES in different types of esophagitis is crucial for diagnosis and treatment.

Purpose of the Study:

• To investigate and compare lower esophageal sphincter pressure (LESP) in healthy subjects and patients with reflux esophagitis.
• To assess the effect of pentagastrin on LESP in these groups and correlate LESP with the severity of esophageal inflammation.

Main Methods:

• Intraluminal perfusion-manometry was used to measure LESP in the resting state and after graded intravenous pentagastrin doses.
• 12 healthy subjects and 27 patients with reflux esophagitis (ulcerative and non-ulcerative) were studied.
• Histological examination and endoscopic appearance classified esophagitis severity.

Main Results:

• A significant correlation was found between reduced mean basal end-expiratory (mbe) LESP and the grade of esophageal inflammation.
• Patients with ulcerative esophagitis exhibited the most reduced mbe LESP, significantly lower than non-ulcerative esophagitis patients and controls.
• LES responsiveness to pentagastrin was quantitatively reduced in ulcerative esophagitis, while non-ulcerative esophagitis patients only differed in maximum mbe pressure.

Conclusions:

• Lower esophageal sphincter pressure is significantly diminished in reflux esophagitis, particularly in ulcerative cases.
• Impaired LES function and reduced responsiveness to pentagastrin are characteristic of ulcerative reflux esophagitis.
• These findings highlight the role of LES dysfunction in the pathophysiology of severe reflux esophagitis.