The effect of medical therapy and antireflux surgery on dysphagia in patients with gastroesophageal reflux disease without esophageal stricture

BACKGROUND: Poor esophageal body motility and trapping of the hernial sac b y the hiatal crura ave the major pathomechanisms of gastroesophageal reflux disease (GERD)-induced dysphagia, There is only little knowledge of the ef fect of medical therapy or antireflux surgery in reflux-induced dysphagia, METHODS: Fifty-nine consecutive GERD patients with dysphagia were studied b y means of a symptom questionnaire, endoscopy, barium swallow, esophageal m anometry, and 24-hour pH monitoring of the esophagus, Patients had proton p ump inhibitor therapy and cisapride for 6 months. After GERD relapsed follo wing withdrawal of medical therapy, 41 patients decided to have antireflux surgery performed. The laparoscopic Nissen fundoplication was chosen in 12 patients with normal esophageal body motility and the laparoscopic Toupet f undoplication in 29 patients with impaired peristalsis. Dysphagia was asses sed prior to treatment, at 6 months of medical therapy, and at 6 months aft er surgery. RESULTS: Heartburn and esophagitis were effectively treated by medical and surgical therapy. Only surgery improved regurgitation, Dysphagia improved i n all patients following surgery but only in 16 patients (27.1%) following medical therapy. Esophageal peristalsis was strengthened following antirefl ux surgery. CONCLUSIONS: Medical therapy fails to control gastroesophageal reflux as it does not inhibit regurgitation, Thus, it has little effect on reflux-induc ed dysphagia. Surgery controls reflux and improves esophageal peristalsis. This may contribute to its superiority over medical therapy in the treatmen t of GERD-induced dysphagia, (C) 1999 by Excerpta Medica, Inc.