CORRELATION OF LOWER ESOPHAGEAL MUCOSAL RING AND 24-H PH MONITORING OF THE ESOPHAGUS

Objective: To study the relationship of LEMR and gastroesophageal refl ux. The pathogenesis of the lower esophageal mucosal ring (LEMR) is no t known. The most likely theory is that the ring results from reflux e sophagitis as part of the morphological spectrum of peptic stricture. Methods: We correlated barium esophagrams and 24-h pH monitoring (pHM) in 343 patients (173 women, 170 men; mean age 52 yr). Patients were c ategorized into three groups by radiographic findings: 2) normal esoph agus (n = 121), 2) hiatal hernia (HH) only (n = 174), and 3) LEMR (n = 48). Abnormal PHM was defined as a total percentage of the esophageal acid exposure time of 6% or more; abnormal pHM was also analyzed rela tive to patient position (supine vs. upright). Results: Findings showe d that 21 (17%) of 121 normal patients had abnormal pHM compared with 58 (33 %) of 174 patients with KH and 15 (31%) of 48 patients with LEM R. Normal patients had a significantly lower frequency of abnormal pHM (p < 0.01) vs. the other two groups; however, no significant differen ce in results of PHM was found in the groups with HH and LEMR. No sign ificant relationships of abnormal supine versus upright pHM was observ ed comparing the three groups. Conclusions: 1) Most patients in this s tudy had normal pHM, regardless of the anatomic status of the esophago gastric region; 2) patients with HH and LEMR had a higher frequency of abnormal pHM, although the two groups were not significantly differen t; and 3) an etiological relationship of LEMR and gastroesophageal ref lux was not supported, other than its association with HH.