Transmural potential difference in patients with hiatus hernia and oesophageal ulcer.

Abstract

Recordings of transmural potential difference (PD) in the stomach have well established that the mucosal surface of this organ is negative in relation to the serosal surface (Rehm, 1946;Revelstad, Owen, and Magath, 1952). On the other hand, it had been noted that the oesophagus has a positive transmural potential difference (Helm, Schlegel, Code, and Summerskill, 1965). The potential difference transition zone from negative to positive values was shown to represent the mucosal transition from acid-bearing to columnar and from columnar to oesophageal mucosa (Meckeler and Ingelfinger, 1967). Utilizing an improved method of recording transmural potential difference (Hernandez and Beck, 1968), we reexamined the characteristics of the potential difference transition zone in normal individuals and in patients suffering from hiatus hernia. In addition, we explored the variations in potential difference which occur over lesions where the mucosal integrity of the oesophagus was destroyed by ulcerations. METHODS RECORDING OF POTENTIAL DIFFERENCE SIMULTANEOUSLYWITH OESOPHAGEAL PRESSURE MEASUREMENTS ('PULL-THROUGH METHOD') Oesophageal pressure and potential difference were measured by a technique previously described and evaluated (Hernandez and Beck, 1968), and measurements of pressure changes were based on the method of Winans and Harris (1967). The main features of the combined method are depicted in Figure 1.For both the pressure and the potential difference recording, Ringer's solution (Na+ = 147 m-equiv/l; K+ = 4 m-equiv/l; Ca++ 4.5 m-equiv/l and Cl-= 156 m-equiv/1 was infused at a rate of 0-382 ml/min. The 50 ml plastic syringes were filled through a three-way plastic stopcock (SC) and placed into a Harvard pump2 (HP) which slowly advanced the plungers. Three of the

Transmucosal potential difference; diagnostic value in gastro-oseophageal reflux.

“…Vidins et al (1971) demonstrated clear abnormalities in patients with a variety of oesophageal pathology. Alterations in potential difference opposite in direction to those reported here were found by Beck and Hernandez (1969) in a group of patients with oesophageal ulceration. However, the pullthrough technique employed by these workers is liable to technical error because of poor contact between the mucosa and exploring electrode.…”

Endoscopic measurement of oesophageal transmucosal potential difference in reflux oesophagitis.

“…The earliest description of PD measurement in oesophageal disease was by Beck and Hernandez in 1969. 15 They described a positive reading in the normal oesophagus and noted a fall towards zero over mucosal ulcerations. Khamis and colleagues in 1978 measured oesophageal PD during endoscopy and found a mean PD of -14 mV in 10 patients with normal mucosal biopsies and +9-4 mV in nine with biopsies showing reflux change.5…”