IMPAIRED ESOPHAGEAL EMPTYING IN REFLUX DISEASE

Objectives: The symptoms and mucosal damage that occur in gastroesopha geal reflux disease (GERD) may be a consequence of either an increased frequency of reflux events or of a prolonged process of esophageal ac id clearance. Acid clearance is dependent both upon effective esophage al emptying of luminal fluid and on normal salivary function to titrat e residual acid to neutrality. This investigation examined the efficac y of esophageal emptying in a large group of GERD patients. Methods: B arium swallow examinations were done to categorize and quantify esopha geal emptying dysfunction in 67 consecutive patients with reflux disea se, compared with 85 patient asymptomatic controls. Quantitative fluor oscopic estimates of esophageal residua were compared with scintigraph ic quantification in 14 controls and 20 GERD patients. Results: There was progressive impairment of esophageal emptying in the reflux patien ts without esophagitis compared with the controls, and it was even gre ater in patients with endoscopically evident esophagitis compared with reflux patients without esophagitis. Good correlation existed between the fluoroscopic and scintigraphic assessment of esophageal emptying. Conclusions: These findings support the hypothesis that impaired esop hageal emptying is an important determinant in the development of esop hagitis among reflux patients. The dominant site of impaired emptying in the reflux patients was the phrenic ampulla as opposed to the tubul ar esophagus, suggesting a pathophysiological contribution of hiatus h ernia.