ESOPHAGEAL HIGH-PRESSURE ZONES - EFFECT OF PERIESOPHAGEAL STRUCTURES ON ESOPHAGEAL MANOMETRIC RECORDING

During the course of esophageal motility studies, short zones of eleva ted esophageal baseline pressure are occasionally noticed. The aim of this study is to determine their frequency and their cause. Among 77 c onsecutive esophageal manometries (group 1), 17 cases (22%) of 'esopha geal high pressure zones' (EHPZs) were recorded. Thirty-three addition al patients (group 2) were evaluated and 18 other cases of EHPZ were f ound; in the latter group, a miniature sound microphone was positioned on a carotid artery. When a high pressure zone was identified, the ma nometric catheter was immobilized; the patient underwent a chest x-ray , with the radiopaque marker imbedded in the catheter used to locate t he thoracic structures adjacent to EHPZs. In both groups, indentations (pressure spikes) over the high pressure zones occurred synchronously with the patients' radial or carotid pulse. Results suggest that EHPZ s are caused by the compression and pulsations of vascular or cardiac periesophageal structures; the aortic arch is responsible for the mano metric EHPZ when it is found between 10 and 14 cm above the lower esop hageal sphincter whereas the left auricle is the cause of the EHPZ if it is located between 4 and 7 cm above the lower esophageal sphincter.