Lower esophageal sphincter (LES) function in cirrhosis was evaluated using an infused manometric system. LES pressure (LESP) in 10 subjects with cirrhosis (22 +/- 1 mm Hg) (mean +/- SE) was not significantly (P greater than 0.05) different from that of 10 control subjects (21 +/- 1 mm Hg) but was significantly (P less than 0.01) greater than the LESP recorded in 5 subjects with cirrhosis and ascites (16 +/- 2 mm Hg). There was no significant difference in LES response to intravenous pentagastrin, intravenous edrophonium, or straight-leg raising in the three groups. After loss of ascitic fluid, LESP significantly (P less than 0.01) increased (deltaP : 9 +/- 3 mm Hg) and gastric pressure (GP) significantly (P less than 0.01) decreased (deltaP: 8 +/- 2 mm Hg). The changes in LESP and GP revealed a significant (R = 0.83, P less than 0.001) linear correlation. These data indicate (1) cirrhosis is associated with normal LES function, and (2) the mechanism of lowered LESP with ascites may be the inability of the LES to maintain a sustained response to chronic increases in GP.