ROLE OF ESOPHAGEAL BODY FUNCTION IN GASTROESOPHAGEAL REFLUX DISEASE -IMPLICATIONS FOR SURGICAL-MANAGEMENT

Background: Effective esophageal peristalsis is a major determinant of esophageal clearance function. The relation of esophageal body functi on with a mechanically defective lower esophageal sphincter and the de velopment of esophageal mucosal injury in patients with gastroesophage al reflux disease is unclear. Study Design: We analyzed the relations among the manometrically determined esophageal clearance function, low er esophageal sphincter dysfunction, esophageal acid exposure, and the presence and severity of esophageal mucosal injury in patients with g astroesophageal reflux disease. Normal values for the manometric asses sment of esophageal clearance function were established in 50 normal v olunteers and subsequently applied to 160 symptomatic patients with in creased esophageal exposure to gastric juice and various grades of eso phageal mucosal injury (no minimal surgery, esophagitis, stricture, an d Barrett's esophagus). Results: Defective clearance function tvas pre sent in 47.5% of the patients; a defective lower esophageal sphincter was documented in 63.1%. Compromised esophageal clearance function was significantly more common in patients with a defective lower esophage al sphincter than in those with normal sphincter function (55% versus 33.8%). Esophageal acid exposure time and the prevalence and severity of esophageal mucosal injury were highest in patients with a defective sphincter and compromised clearance function. Conclusions: These data show that esophageal motor function deteriorates with increasing seve rity of mucosal injury. This appears to be due to persistent reflux of gastric juice across a mechanically defective lower esophageal sphinc ter. This may influence the choice and outcome of antireflux surgery. Surgical correction of a mechanically defective sphincter before the l oss of esophageal body function is advocated. (C) 1997 by the American College of Surgeons.