1982 Volume 24 Issue 3 Pages 422-430_1
Relationship of the esophagogastric junction (Z-line pattern) and the functions of the esophagus was studied in the patients with reflux esophagitis. We classified Z-line pattern Z0-type to Z4-type, on a point of view of the shape and the level of the Z-line. Lower esophageal sphincter pressure (LESP) was messured by open-tip infusion method and acid clearing test was messured by Booth's method (0.1 N HCl 15 ml). Z-line classification endoscopically was as following: Z0-type is normal Z-line pattern and no evidence of esophagitis and hiatus hernia, Z1-type to Z3-type of the Z-line pattern were classified in proportion to the shape of the Z-line, Z1-type is slihtly indented on those Z-line changes, Z2-type is mild and Z3-type is severe, and Z-line of Z4-type is a way from the esophageal hiatus, but is straightly on the shape, no evidence of esophagitis. Following results were obtained: 1. LESP was 15.5±5.6 cmH2O (M + SD) in normal subjects (Z0-type), it was 10.3±2.9 cmH2O in Z1-type, 9.5±4.9 cmH2O in Z2-type, 9.4±4.1 cmH2O in Z3-type and 7.6+3.4 cmH2O in Z4-type. There were statistically significant difference between 4-type and the other Z-line patterns (p<0.05, p<0.05, p<0.025 and p<0.025 respectively). 2. Acid clearance was shown as the time until the pH returned to 5.0 due to swallowing at one-minute intervals. The result of acid clearing test was 11.4±3.0 min in 4-type, 18.3±7.0 min in Z1-type, 20.3±5.6 min in 4-type, 24.1±5.7 min in Z3-type and 24.5±7.4 min in Z4-type. Acid clearance were signicantlly delayed along with Z-line pattern (p<0.025, p<0.025, p<0.005 and p<0.005 respectively) 3. The patients with hiatus hernia were 5 cases of Z3-type and 6 cases of Z4-type. They had low LESP and delayed acid clearance.As above mentioned, the results of LESP and acid clearing test were well related to Z-line patterns in patients with reflux esophagitis.
