Selection of patients with gastroesophageal reflux disease for antireflux surgery based on esophageal manometry

Gastroesophageal reflux disease (GERD) is caused by a mechanically defective lower esophageal sphincter (LES) and may be worsened by impaired esophageal peristalsis. The aim of this study was to evaluate the efficacy of medical treatment depending on the function of the LES and esophageal peristalsi...

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Bibliographic Details
Published in:Digestive diseases and sciences 2003-09, Vol.48 (9), p.1719-1722
Main Authors: KLAUS, Alexander, GADENSTAETTER, Michael, MÜHLMANN, Gilbert, KIRCHMAYR, Werner, PROFANTER, Christoph, ACHEM, Sami R, WETSCHER, Gerold J
Format: Article
Language:English
Subjects:
Adult
Aged
Biological and medical sciences
Esophagus
Esophagus - physiopathology
Female
Gastroesophageal Reflux - drug therapy
Gastroesophageal Reflux - physiopathology
Gastroesophageal Reflux - surgery
Humans
Male
Manometry
Medical sciences
Middle Aged
Patient Selection
Peristalsis
Recurrence
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the digestive system
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Summary:Gastroesophageal reflux disease (GERD) is caused by a mechanically defective lower esophageal sphincter (LES) and may be worsened by impaired esophageal peristalsis. The aim of this study was to evaluate the efficacy of medical treatment depending on the function of the LES and esophageal peristalsis. We studied 128 GERD patients with mild esophagitis. Group 1 (N = 26) consisted of patients with a normal LES and normal esophageal peristalsis. Group 2 (N = 63) comprised patients with a defective LES but normal peristalsis. Patients of group 3 (N = 39) had a defective LES as well as impaired esophageal peristalsis. The patients were continuously treated with omeprazole. Clinical evaluation and endoscopy were repeated after 3, 6, and 12 months. Recurrence of GERD was diagnosed if there was relapse of heartburn and/or esophagitis. The recurrence rate was 7.7% in group 1, 38.1% in group 2 (P < 0.05) and 79.5% in group 3 (P < 0.05). In conclusion, in GERD patients with a mechanically defective LES, especially in those with deteriorated esophageal peristalsis, antireflux surgery should be considered since medical therapy reveals a high recurrence rate.
ISSN:0163-2116
1573-2568
DOI:10.1023/A:1025434726161