Characteristics of secondary oesophageal peristalsis in operated and non-operated patients with chronic gastrooesophageal reflux disease

Background and aims Secondary oesophageal peristalsis contributes to oesoph ageal volume clearance and may be impaired in a significant proportion of p atients with chronic gastro-oesophageal reflux disease (GORD). This study a imed to investigate the triggering of secondary peristalsis in chronic GORD patients compared tot those previously operated on with anti-reflux surger y. Patients and methods Healthy volunteers, chronic GORD patients with proven oesophagitis and patients successfully operated on with anti-reflux surgery (>3 years ago) were investigated. Secondary peristalsis was elicited by oe sophageal distension by a bolus of air (10 mi) injected rapidly into the mi d-portion of the oesophagus. The peristaltic characteristics in the distal oesophagus were assessed by use of stationary manometry. Results The primary peristaltic amplitude in the distal third of the oesoph agus was significantly higher (P < 0.002) in the non-operated GORD cases th an in those recruited for surgery. Furthermore, a difference in the frequen cy of failed primary peristalsis was revealed (2.1 versus 8.4%) between the non-operated and operated patients. Secondary peristalsis occurred in 65 /- 13.2% (mean +/- SE) of the healthy subjects on stimulation, which was a higher figure than in the GORD patients. In patients investigated after suc cessful anti-reflux surgery, a secondary peristaltic wave was elicited in o nly 26 +/- 7.2% of the attempts, which was significantly lower than the 46 +/- 7.7% seen in nonoperated GORD patients (P < 0.05). A direct comparison between motor characteristics of primary and secondary peristalsis revealed that the latter amplitudes were significantly lower both in the non-operat ed and in the operated cases (P < 0.005). Conclusions The triggering of secondary peristalsis seems to be impaired in chronic GORD patients. Investigating similar patients >3 years after succe ssful anti-reflux surgery revealed an even lower prevalence of secondary pe ristaltic waves, implying persistence of the abnormality after surgery and consistent with other evidence that GORD is associated with a primary defec t in oesophageal motor function. Eur J Gastroenterol Hepatol 12:739-743 (C) 2000 Lippincott Williams & Wilkins.