ESOPHAGEAL MOTILITY ABNORMALITIES IN CIRRHOTIC-PATIENTS BEFORE AND AFTER ENDOSCOPIC VARICEAL TREATMENT

Esophageal motility abnormalities in patients treated endoscopically f or variceal hemorrhage are rarely studied and usually are not addresse d in the clinical setting, However, a review of the literature reveale d that esophageal varices reduce the mean amplitude and increase the m ean duration of peristaltic waves but have little effect on lower esop hageal sphincter function, Transit time is delayed and gastroesophagea l reflux disease is common in up to 64% of the patients, Whereas band ligation appears to have little impact on esophageal motility, data ar e limited and are hampered by lack of standardization, rendering concl usions about safety rather premature, Injection sclerotherapy spares t he lower esophageal sphincter, as well, but it significantly reduces m ean amplitude contractions, mainly in the lower one-third to one-half of the esophagus, In addition, normal peristalsis may be occasionally or completely replaced by nonpropagating simultaneous contractions tha t may result in chest pain and/or dysphagia in the absence of strictur e, Transient prolongation of acid clearance usually resolves within a week, except in patients who have developed stricture, Pathogenesis of the abnormal motility remains poorly understood, and treatment has be en empirical, However, a short course of anti-reflux treatment after e ach therapeutic session is justified, as well as long-term treatment f or patients with stricture, The choice of treatment for esophageal mot ility abnormalities is less clear and requires future studies.