The American Journal of Digestive Diseases

, Volume 17, Issue 5, pp 415–422 | Cite as

A test of gastroesophageal sphincter competence

The common cavity test
  • Donald G. Butterfield
  • John E. StruthersJr
  • J. Philip
  • Showalter BS


Gastroesophageal manometrics, using continuously perfused polyvinyl tubes, and acid reflux (pH test) were studied prospectively in 13 patients with, and 14, without symptoms and/or signs of gastroesophageal reflux. Pressures were recorded simultaneously from stomach, gastroesophageal sphincter and distal esophagus at rest and during gradual abdominal compression to 80 mm Hg. Neither the mean resting pressures nor the mean increase in gastric or sphincter pressures, during abdominal compression, were significantly different (P>0.10). Sphincteric yield pressures did not separate the 2 groups. However, the mean esophageal pressure rise was significantly greater (P<0.001) in the symptomatic patients (34±4.5 vs 9.9±3.2 mm Hg). The mean pressure in the stomach, sphincter and esophagus became almost identical in the symptomatic patients—a “common cavity” occurred between stomach and esophagus. Two symptomatic patients had negative pH but positive common cavity tests. No asymptomatic patient had evidence of either reflux or a positive common cavity test.


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  1. 1.
    Vantrappen G, Texter EC Jr, Barborka CJ, et al: The closing mechanism at the gastroesophageal junction. Am J Med 28:564–577, 1960PubMedGoogle Scholar
  2. 2.
    Fyke FE Jr, Code CF, Schlegel JF: The gastroesophageal sphincter in healthy human beings. Gastroenterologia (Basel) 86:135–150, 1956PubMedGoogle Scholar
  3. 3.
    Fleshler B, Hendrix TR, Kramer P, et al: Resistance and reflex function of the lower esophageal sphincter. J Appl Physiol 12:339–342, 1958PubMedGoogle Scholar
  4. 4.
    Botha GSM, Astley R, Carre IJ: The gastroesophageal junction. Lancet 1:659–662, 1957Google Scholar
  5. 5.
    Lind JR, Warrian WG, Wankling WJ: Responses of the gastroesophageal junctional zone to increases in abdominal pressure. Can J Surg 9:32–38, 1966PubMedGoogle Scholar
  6. 6.
    Nagler R, Spiro HM: Segmental response of the inferior esophageal sphincter to elevated intragastric pressure. Gastroenterology 40:405–407, 1961PubMedGoogle Scholar
  7. 7.
    Van Derstappen G, Texter EC Jr: Response of the physiologic gastroesophageal sphincter to increased intra-abdominal pressure. J Clin Invest 43:1856–1868, 1964PubMedGoogle Scholar
  8. 8.
    Botha CSM: Mucosal folds at the cardia as a component of the gastroesophageal closing mechanism. Br J Surg 45:569–580, 1958PubMedGoogle Scholar
  9. 9.
    Farhad I, Horton PF, Pope CE II: Histological consequences of gastroesophageal reflux in man. Gastroenterology 58:163–174, 1970PubMedGoogle Scholar
  10. 10.
    Haddad JK: Relation of gastroesophageal reflux to yield sphincter pressures. Gastroenterology 58:175–184, 1970PubMedGoogle Scholar
  11. 11.
    Morgan EH, Hill LD, Selby DK: Objective assessment of gastroesophageal reflux secondary to hiatal hernia. Dis Chest 43:367–376, 1963Google Scholar
  12. 12.
    Harris LD, Pope CE II: The pressure inversion point: its genesis and reliability. Gastroenterology 51:641–648, 1966PubMedGoogle Scholar
  13. 13.
    Tuttle SG, Bettarello A, Grossman MI: Esophageal acid perfusion test and a gastroesophageal reflux test in patients with esophagitis. Gastroenterology 38:861–872, 1960PubMedGoogle Scholar
  14. 14.
    Code CF, Kelley ML Jr, Schlegel JF, et al: Detection of hiatal hernia during esophageal motility tests. Gastroenterology 43:521–531, 1962PubMedGoogle Scholar
  15. 15.
    Tuttle SG, Grossman MI: Detection of gastroesophageal reflux by simultaneous measurement of intraluminal pressure and pH. Proc Soc Exp Biol Med 98:225–227, 1958PubMedGoogle Scholar
  16. 16.
    Piccone VA, Gutelius JR, McCorriston JR: A multiphased esophageal pH test for gastroesophageal reflux. Surgery 57:638–646, 1965PubMedGoogle Scholar
  17. 17.
    Marchand P: The gastroesophageal “sphincter” and the mechanism of regurgitation. Br J Surg 42:504–513, 1955PubMedGoogle Scholar
  18. 18.
    Nagler R, Spino HM: Serial esophageal motility studies in asymptomatic young subjects. Gastroenterology 41:371–379, 1961PubMedGoogle Scholar
  19. 19.
    Siegel CI, Hendrix TR: The clinical value of esophageal motor studies. Postgrad Med J 29:505–512, 1961Google Scholar
  20. 20.
    Winans CS, Harris LD: Quantitation of lower esophageal sphincter competence. Gastroenterology 52:773–778, 1967PubMedGoogle Scholar
  21. 21.
    Pope CE II: A dynamic test of sphincter strength: its application to the lower esophageal sphincter. Gastroenterology 52:779–786, 1967PubMedGoogle Scholar
  22. 22.
    Cohen S, Harris LD: Lower esophageal sphincter pressure as an index of lower esophageal sphincter strength. Gastroenterology 58:157–162, 1970PubMedGoogle Scholar
  23. 23.
    Heitmann P, Wolf BS, Sokol EM, et al: Simultaneous cineradiographic-manometric study of the distal esophagus: small hiatal hernias and rings. Gastroenterology 50:737–753, 1966PubMedGoogle Scholar
  24. 24.
    Skinner DB, Camp TF Jr: Relation of esophageal reflux to lower esophageal sphincter pressures decreased by atropine. Gastroenterology 54:543–551, 1968PubMedGoogle Scholar
  25. 25.
    Cohen S, Harris LD: Does hiatus hernia affect competence of the gastroesophageal sphincter? N Engl J Med 284:1053–1056, 1971PubMedGoogle Scholar
  26. 26.
    Wolf BS: The esophogastric closing mechanism. J Mt Sinai Hosp 27:404–416, 1960Google Scholar
  27. 27.
    Wankling WJ, Warrian WG, Lind JF: The gastroesophageal sphincter in hiatus hernia. Can J Surg 8:61–67, 1965Google Scholar
  28. 28.
    Crispin JS, McIver DK, Lind JK: Manometric study of the effect of vagotomy on the gastroesophageal sphincter. Can J Surg 10:299–303, 1967PubMedGoogle Scholar
  29. 29.
    Giles GR, Mason MC, Humphries C, et al: Action of gastrin on the lower esophageal sphincter in man. Gut 10:730–734, 1969PubMedGoogle Scholar
  30. 30.
    Cohen S, Lipshutz W: Hormonal regulation of human lower esophageal sphincter competence: interaction of gastrin and secretin. J Clin Invest 50:449–454, 1971PubMedGoogle Scholar

Copyright information

© Paul B. Hoeber, Inc. 1972

Authors and Affiliations

  • Donald G. Butterfield
    • 1
  • John E. StruthersJr
    • 1
  • J. Philip
    • 1
  • Showalter BS
    • 1
  1. 1.From the Division of Gastroenterology, Department of MedicineUniversity of Colorado Medical Center and Denver Veterans Administration HospitalDenver

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