Gastroesophageal sphincter pressure (GESP) and serum gastrin concentration (SGC) were determined in the basal state and after a protein meal in six patients with duodenal ulcer (DU), six patients after parietal cell vagotomy (PCV), six patients after selective gastric vagotomy plus drainage (SGV + D), and six patients after selective gastric vagotomy plus precise antrectomy (SGV + A). No correlation in the resting state between GESP and SGC was observed. After food ingestion, DU patients showed a sustained rise in GESP which lasted up to the end of the experiment. The vagotomized patients, however, showed no rise in sphincter pressure after food intake--rather a tendency to a decrease in pressure occurred. On the contrary, SGC rose significantly after food ingestion in patients with SGV + D or PCV, while in DU patients this rise was less significant. Patients with vagotomy and antrectomy showed no rise in SGC. These results do not suggest that SGC and extrinsic vagal innervation in the resting state play a significant role in the maintenance of the tone of GES. After food ingestion an interaction may occur between intact vagal innervation and rise in SGC in order to obtain an adequate rise in GESP.

Gastroesophageal sphincter pressure (GESP) and contractile waves of the esophagus were measured in 113 normal subjects ranging in age between 2 months and 74 years. The amplitude and duration of the peristaltic waves of the thoracic esophagus were similar in both children and adults. Resting GESP pressures were dependent upon age. In children under one year, high pressures were recorded. The high pressures gradually diminished until between 15 and 24 years, whereafter they remained at similar values up to 65 years. After this age, a further decline in pressure was observed. The importance of these findings are discussed.

Pyloric sphincter pressure was assessed with water-perfused polyvinyl tubes. Smoking one cigarette significantly decreased the basal pyloric pressure, whereas 10 mg of metoclopramide as an intravenous bolus increased the pyloric pressure in normal subjects and in patients with gastric ulcer with low basal pressure. Duodenal acidification with 0.1 N HCl significantly increased pyloric pressure. Atropine 15 mug per kg, subcutaneously prevented the rise of pyloric pressure in response to acid infusion into the duodenum.

Radiographic, manometric, simultaneous radiographic-manometric, endoscopic, histologic and gastric secretory studies were performed on 12 consecutive patients with a benign peptic esophageal stricture. All patients had a segment of esophagus lined with columnar epithelium below the stricture and a small hiatal hernia. Four of them had a normotensive competent gastroesophageal sphincter and no evidence for reflux. Eight patients had free gastroesophageal reflux through a weak, incompetent sphincter. Esophagitis was not universally present. The type of heterotopic mucosa as well as the gastric secretory values showed no uniform pattern. Four patients with a fundic type of epithelium in the lower esophagus had discrete esophageal ulcers, but only 2 of them had evident gastroesophageal reflux. Local secretion of gastric juice seems to play a role in the genesis of these ulcers. There are strong arguments in favor of a congenital heterotopic mucosal lining in the lower esophagus in some patients, although a contributing role for reflux esophagitis cannot be excluded in others.

l-undl-Isomere von Alanin und Serin sind beide wirksam, von der Antrumschleimhaut aus den Gastrinmechanismus zu aktivieren.

Intraluminal manometric studies were performed in 30 normal adults and in 16 symptomatic patients with the radiological features of achalasia by the use of a constant catheter perfusion technique. A normotensive gastroesophageal sphincter was found in every patient with achalasia. Sphincteric fall in pressure on swallowing was found in 92.7 per cent of the swallows in 12 of the 16 patients with achalasia. In 4 patients, no fall in sphincteric pressure was recorded on swallowing. A significant increase in resting sphincteric pressure after subcutaneous injection of an acetylcholine derivative is described. 98 per cent of swallows were followed by sphincteric fall in pressure under the action of this agent in all patients tested. The nature of the dynamic abnormality most frequently found in achalasia is discussed. It is concluded that results obtained with the use of a constant catheter perfusion technique during intraluminal pressure measurements should lead to a re-evaluation of currently accepted concepts on the pathophysiology of achalasia.Key-words: Esophagusachalasiapressure recordingsmotilitygastroesophageal sphincter