Lower esophageal sphincter relaxation characteristics using a sleeve sensor in clinical manometry

Objective: We undertook this study to determine the characteristics of swal low-induced lower esophageal sphincter (LES) relaxation in the setting of c linical manometry using a standardized methodology. Methods: We reviewed 17 0 manometric recordings performed using a perfused manometric assembly with a sleeve sensor and a computer polygraph. Patients were categorized as pat ient controls, gastroesophageal reflux disease (GERD), diffuse esophageal s pasm (DES), or achalasia. Tracing were semiautomatically analyzed for basal LES pressure, LES pressure during deglutitive relaxation (relaxation LES p ressure), duration of LES relaxation, timing of LES relaxation, and the suc cess rate of primary peristalsis. Results: Forty-six patient controls, 93 w ith GERD, five with DES, and 26 with achalasia were identified. GERD and ac halasia patients had lower or higher basal LES pressures than patient contr ols, respectively. Compared with patient controls, achalasia patients had h igher relaxation LES pressures, lower percent LES relaxation, and shorter d urations of LES relaxation. The best single measure for distinguishing acha lasia was the relaxation LES pressure; using the 95th percentile value of p atient controls (12 mm Hg) as the upper limit of normal, its sensitivity an d positive predictive value for the diagnosis of achalasia were 92% and 88% , respectively. Coupled with the finding of aperistalsis, a relaxation LES pressure greater than or equal to 10 mm Hg achieved 100% sensitivity and po sitive predictive value among these patients. Conclusions: Sleeve sensor re cording is a practical method for clinical manometry that reliably records LES relaxation characteristics and is amenable to both a standardized manom etry protocol and a semiautomated analysis routine. Relaxation LES pressure has a high diagnostic value for achalasia. (C) 1998 by Am. Coll. of Gastro enterology.