DIMINISHED ESOPHAGEAL TRACTION FORCES WITH SWALLOWING IN GASTROESOPHAGEAL REFLUX DISEASE AND IN FUNCTIONAL DYSPHAGIA

Relations between primary oesophageal peristaltic amplitude and tracti on force were studied in 30 normal volunteers, 12 patients with functi onal dysphagia, and 48 patients with gastro-oesophageal reflux disease , using a new intraluminal strain gauge device. Forces generated by sw allowing in the normal oesophagus were 42 (35-60)g (median and interqu artile range), a close positive correlation existing between traction force and contractile amplitude for each subject (r=0.5 (0.38-0.6). Tr action force increased with increasing balloon volume from 62 (50-73) g at 2 mi to 86 (70-105)g at 4 mi (p<0.05), indicating distension rela ted modulation of peristaltic force. Patients with oesophagitis genera ted lower traction forces on swallowing 30 (20-40) g compared with the normal subjects (p<0.01), the degree of impairment being greatest in those patients with the most severe mucosal damage. Patients with gast ro-oesophageal reflux without endoscopic oesophagitis also showed abno rmal forces (32 22-38)g p<0.01 v controls), which were similar to thos e patients with mild oesophagitis but were greater than those with sev ere oesophagitis (p<0.05). In patients with functional dysphagia, forc es were also impaired (28 (10-60) g p<0.05 v controls) despite normal standard manometry. Our results show that measurement of the traction force generated by primary peristalsis provides information about oeso phageal neuromuscular function that is not demonstrable by manometry a lone and can be abnormal in patients with oesophageal symptoms in whom standard techniques are normal.