Esophageal function in patients with reflux-induced strictures and its relevance to surgical treatment

Giovanni Zaninotto, Tom R. DeMeester, Cedric G. Bremner, Thomas C. Smyrk, Shih Chuan Cheng

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Abstract

Esophageal function was evaluated in 53 patients with increasing severity of esophageal injury caused by gastroesophageal reflux disease (study 1), and the findings were applied to the treatment of 28 patients with refluxinduced strictures (study 2). Fifty asymptomatic volunteers served as controls for both studies. In study 1 there were 14 patients without reflux complications, 14 with esophagitis grade I to III, 13 with esophageal stricture, and 12 with Barrett's epithelium (6 of whom had a stricture). The prevalence of a mechanically defective sphincter increased with the progression of the esophageal injury; 50% in the patients without complications to 84% and 92% in those with stricture or Barrett's epithelium, respectively. Similarly, a decrease in amplitude of contractions in the distal esophagus was observed in patients with stricture and patients with Barrett's epithelium. In study 2, these findings were applied in the surgical management of 28 consecutive patients with a reflux-induced stricture. Preoperative motility studies were performed after patients were dilated to 60F. Control of reflux by a Nissen fundoplication gave excellent (86%) to good (14%) results in patients who had relief of dysphagia after dilation or adequate motility, or both. Four patients with both persistent dysphagia after dilation and inadequate motility underwent resection. Transmural fibrosis was observed in all specimens. The criteria presented are helpful in the selection of the optimal surgical procedure for the treatment of dilatable refluxinduced strictures.

Original languageEnglish (US)
Pages (from-to)362-370
Number of pages9
JournalThe Annals of Thoracic Surgery
Volume47
Issue number3
DOIs
StatePublished - Mar 1989

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All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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