title: Significant pressure differences between solid-state and water-perfused systems in lower esophageal sphincter measurement.
abstract: OBJECTIVE
  High-resolution manometry of the esophagus has gained worldwide acceptance, using different solid-state catheters. Thus, normal values for lower esophageal sphincter (LES) resting pressure in suspected gastroesophageal reflux disease patients have been established using water-perfused manometry. These standard values are commonly applied using also solid-state techniques, although they have never been compared before. The aim of the study was to compare LES measurements obtained with water-perfused manometry with a solid-state technique.
  
  
  METHODS
  Thirty healthy subjects were studied twice on the same day: Technique 1: Station pull through using a water-perfused catheter with ports arranged at 0°, 90°, 180° and 270° which were averaged to give a mean LES pressure. Technique 2: Solid-state circumferential probe with a single station pull through. Data were collected using the same computer system and program. The LES pressures were randomly and blindly analyzed.
  
  
  RESULTS
  Twenty-seven subjects out of 30 were analyzed. Using the solid-state system, the mean LES pressure was higher (15.0 vs. 23.3 mmHg, p = 0.003) and 19 of 27 (70%) individual measurements were higher. Two subjects had a hypertensive LES by solid state (58.6 resp. 47.5 mmHg), while their pressures were normal with water-perfused manometry (21.0 resp. 23.4 mmHg). The distal esophageal pressures (mean of pressure at 3 and 8 cm above LES) were the same with the two techniques.
  
  
  CONCLUSIONS
  In normal control subjects, LES measurement using circumferential solid-state transducers yields higher pressures than standard water-perfused manometry. Which system yields the "true" resting pressure of the physiologic LES remains to be determined.
authors.affiliation: Center of Operative Medicine, Department of Visceral, Transplant and Thoracic Surgery, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria. philipp.gehwolf@i-med.ac.at.
authors.forename: Philipp
authors.initials: P
authors.lastname: Gehwolf
authors.affiliation: Department of Surgery, Mayo Clinic Jacksonville, Jacksonville, FL, USA.
authors.forename: Ronald A
authors.initials: RA
authors.lastname: Hinder
authors.affiliation: Department of Gastroenterology, Mayo Clinic Jacksonville, Jacksonville, FL, USA.
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: DeVault
authors.affiliation: Department of Medical Statistics, Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Edlinger
authors.affiliation: Center of Operative Medicine, Department of Visceral, Transplant and Thoracic Surgery, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria. heinz.wykypiel@i-med.ac.at.
authors.forename: Heinz F
authors.initials: HF
authors.lastname: Wykypiel
authors.affiliation: Center of Operative Medicine, Department of Visceral, Transplant and Thoracic Surgery, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.|Department of Surgery, Mayo Clinic Jacksonville, Jacksonville, FL, USA.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Klingler
mesh_terms: D000328:Adult; D015154:Esophageal Motility Disorders / Q000503:physiopathology; D049630:Esophageal Sphincter, Lower / Q000502:physiology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000503:physiopathology; D006801:Humans; D008297:Male; D008365:Manometry / Q000295:instrumentation / Q000379:methods*; D012016:Reference Values; D014867:Water
chemical_list: D014867:Water
keywords: GERD; Gastroesophageal junction; Lower esophageal sphincter (LES); Manometry