Contribution of measurement of lower oesophageal sphincter pressure and relaxation in diagnostic oesophageal manometry

The diagnostic value of measurements of lower oesophageal sphincter (LOS) pressure and relaxation was assessed in relation to other tests of oesophageal function in 100 consecutive patients referred with heartburn, dysphagia and/or non-cardiac chest pain. There were no differences in resting LOS pressures between those with and without dysphagia nor in those with and without chest pain. Sphincter relaxation after 5 ml water swallows was incomplete ('residual pressure' >5mmHg) in 11 patients with dysphagia, nine of whom had abnormal oesophageal body motility and in 10 patients with chest pain of whom five had abnormal motility. Eleven patients with dysphagia and 20 patients with chest pain had normal transit, pH and manometric studies. Oesophageal function tests may be normal in patients with chest pain or dysphagia. Evaluation of LOS pressure and relaxation is of very little diagnostic value in patients with chest pain and is only important in those with dysphagia when it is associated with disturbances of oesophageal peristalsis.