Volume 41, Issue 3, Pages 303-314 (March 1962) The Value of the Esophageal Motility Test in the Evaluation of Thoracic Pain Problems  C. DUWAYNE SCHMIDT, M.D., HURLEY D. JONES, M.D., JAMES C. HUNT, M.D., CHARLES F. CODE, M.D., MILTON W. ANDERSON, M.D., F.C.C.P., HOWARD A. ANDERSEN, M.D., F.C.C.P.  Diseases of the Chest  Volume 41, Issue 3, Pages 303-314 (March 1962) DOI: 10.1378/chest.41.3.303 Copyright © 1962 The American College of Chest Physicians Terms and Conditions

Figure 1 Balloon-transducer assemblies and open-tipped tubes used for the determination of pressures in the esophagus and its sphincters. Diseases of the Chest 1962 41, 303-314DOI: (10.1378/chest.41.3.303) Copyright © 1962 The American College of Chest Physicians Terms and Conditions

Figure 2 Resting and deglutition pressures in the normal esophagus and gastroesophageal sphincter (group 1). Upper panel. This is a record of the resting pressure of the gastroesophageal sphincter as detected by a balloon-covered transducer. At each upward arrow the pressure detector was withdrawn 0.5 cm. from the stomach toward the esophagus and finally into it. The deflections of pressure with inspiration are positive in the stomach and first portion of the sphincter, but they suddenly become negative with a deep breath at the mid-portion of the sphincter and are negative with inspiration from that point through the sphincter into the esophagus. Lower panels. The point of respiratory reversal is taken as the physiologic hiatus. Deglutitive responses are depicted. Diseases of the Chest 1962 41, 303-314DOI: (10.1378/chest.41.3.303) Copyright © 1962 The American College of Chest Physicians Terms and Conditions

Figure 3 Excessive contractions low in the esophagus of a patient with diffuse spasm (group 3). Diseases of the Chest 1962 41, 303-314DOI: (10.1378/chest.41.3.303) Copyright © 1962 The American College of Chest Physicians Terms and Conditions

Figure 4 Resting pressures of the gastroesophageal junction in a patient with a hiatal hernia (group 3). With inspiration the pneumograph recorded an upward deflection. When the pressure detector rested in the stomach, the deflections with inspiration were positive (upward). These became negative for a short distance soon after the detector entered the sphincter, then positive again, and then negative once more toward the upper end of the sphincter and in the esophagus. This constitutes a double respiratory reversal at the junctional zone. Not all patients with hiatal hernia present this sign. Diseases of the Chest 1962 41, 303-314DOI: (10.1378/chest.41.3.303) Copyright © 1962 The American College of Chest Physicians Terms and Conditions

Figure 5 Hypertensive gastroesophageal sphincters in three patients as detected balloon transducers. At each upright arrow, the pressure-detecting unit was withdrawn 0.5 cm. from the stomach toward and into the esophagus. Diseases of the Chest 1962 41, 303-314DOI: (10.1378/chest.41.3.303) Copyright © 1962 The American College of Chest Physicians Terms and Conditions

Figure 6 Hypertensive, hyperreacting gastroesophageal sphincter in a patient with hiatal hernia (group 3). Upper panel. The resting pressure detected by the balloon transducer as the unit was withdrawn from the stomach into the esophagus. The zone of high pressuure is broad; a plateau of pressure is present in which the pressure responses to respiration are mixed, sometimes being positive and sometimes being negative. Lower panels. During deglutition, as depicted in the lower two panels, the sphincter contracted with excessive force and for prolonged periods. Diseases of the Chest 1962 41, 303-314DOI: (10.1378/chest.41.3.303) Copyright © 1962 The American College of Chest Physicians Terms and Conditions

Figure 7 Deglutitive contractions before and after a dose of nitroglycerin in a patient with diffuse spasm of the esophagus and hypercontracting gastroesophageal sphincter (group 4). Upper panel. The deglutitive responses prior to the administration of nitroglycerin. The simultaneous and repetitive contractions in the esophagus, the poor relaxation of the sphincter, and the powerful sphincteric contraction should be npted. Lower panel. After nitroglycerin the contractions in the esophagus are more orderly, are less powerful, and are no longer repetitive, and hypercontraction in the sphincter has been eliminated. Associated with these changes in motility the patient reported relief of pain. Diseases of the Chest 1962 41, 303-314DOI: (10.1378/chest.41.3.303) Copyright © 1962 The American College of Chest Physicians Terms and Conditions