Lower esophageal sphincter measurement in four different quadrants in normals and patients with achalasia

In order to determine the endoluminal pressure force distribution, the pressure in the lower esophageal sphincter (LES) and esophageal body was recorded in healthy volunteers and patients with achalasia, using a new waterperfused circular four-channel-sleeve (FCS) manometry catheter. The median lower esophageal sphincter pressure (LESP) and interquartile range in healthy control subjects (group 1) was significantly higher in the left lateral quadrant: 37 (28-43) mmHg (channel III) (P < 0.001), in comparison to the right lateral: 24 (20-25) mmHg (channel I), anterior: 22 (18-30) mmHg (channel II), and posterior quadrant: 24 (22-28) mmHg (channel IV). The median LESP in achalasic patients (group 2) was significantly increased in channel I: 31 (27-36) mmHg, channel II: 35 (28-39) mmHg, and in channel IV: 29 (26-237) mmHg (P < 0.001) when compared to controls. The detected pressure of the left lateral quadrant of the LES was not found to be significantly different from controls: 38 (29-39) mmHg. The median contraction amplitude of healthy subjects was significantly higher when compared with achalasic patients (P < 0.001). In patients with achalasia (group 2) the median contraction amplitude of the proximal esophagus was significantly higher than the distal contraction amplitude. In contrast, healthy volunteers showed a reverse relationship. No asymmetric pressure force was detected with the FCS in the proximal or distal esophageal body in either group. In conclusion, the abolition of the normal manometric LES asymmetry in patients with achalasia might indicate regional variations of muscle functions in the high pressure zone of the gastroesophageal junction (GEJ).