ESOPHAGEAL MANOMETRY AND AMBULATORY 24-HOUR PH MONITORING IN PATIENTSWITH SHORT AND LONG-SEGMENT BARRETTS-ESOPHAGUS

Objective: Short segment Barrett's esophagus (SSBE) is defined as the presence of specialized intestinal metaplasia (SIM) in the distal 2-3 cm of the esophagus. Although gastroesophageal reflux and heartburn is very common in these patients, the pathophysiology of the development of a short segment of SIM versus a longer segment of Barrett's epithe lium is not clear. The aim of this study was to assess the extent of g astroesophageal reflux in short versus long segments of SIM. Methods: Of 203 consecutive patients undergoing endoscopy with two biopsies per formed just distal to the squamocolumnar junction, 28 patients were id entified as having SSBE as evidenced by SIM on biopsy. Twenty-two SSBE patients underwent esophageal manometry and W-h dual pH monitoring, a nd the results were compared with 18 long segment Barrett's esophagus (LSBE) patients and 15 patients with normal W-h pH studies. Results: S SBE and LSBE patients were significantly older than normal subjects (p < 0.0001). Also, lower esophageal sphincter pressure was significantl y greater in SSBE patients compared with LSBE patients (12.3 +/- 1.6 v s 5.2 +/- 1.0 mm Hg,p < 0.0008). LSBE patients had a significantly low er distal esophageal peristaltic amplitude as compared with normals (p < 0.012). At 5 cm proximal to the LES, SSBE patients had significantl y lower total 24-h pH scores, percent upright and percent supine reflu x as compared with LSBE patients. Similarly, when measured at the prox imal LES (0 cm), SSBE patients had significantly lower 24-h pH scores when compared with LSBE patients (p < 0.03), whereas percent upright a nd percent supine reflux were not significantly different. Both LSBE a nd SSBE patients had a greater degree of GER measured at 5 cm above an d just proximal to the LES when compared with normals. Conclusion: As a group, SSBE patients have more competent LES sphincters and less gas troesophageal reflux at 0 and 5 cm above the LES as compared with pati ents with LSBE. These data indicate that the degree and length of acid exposure in the esophagus are important factors in the pathogenesis o f SIM involvement of the esophagus. (C) 1998 by Am. Coll. of Gastroent erology.