The role of a defective lower esophageal sphincter in the clinical outcome of treatment for gastroesophageal reflux disease

• Published in: Archives of surgery (Chicago. 1960) Vol. 131; no. 6; p. 655
• Main Authors: Costantini, M, Zaninotto, G, Anselmino, M, Boccù, C, Nicoletti, L, Ancona, E
• Format: Journal Article
• Language: English
• Published: United States 01.06.1996
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Ulcer Agents - therapeutic use; Data Interpretation, Statistical; Esophagogastric Junction - physiology; Female; Follow-Up Studies; Fundoplication; Gastroesophageal Reflux - drug therapy; Gastroesophageal Reflux - physiopathology; Gastroesophageal Reflux - surgery; Histamine H2 Antagonists - therapeutic use; Humans; Hydrogen-Ion Concentration; Male; Manometry; Middle Aged; Monitoring, Physiologic; Omeprazole - therapeutic use; Prospective Studies; Software; Time Factors; Treatment Outcome
• ISSN: 0004-0010
• DOI: 10.1001/archsurg.1996.01430180081017

To evaluate the clinical role of a defective lower esophageal sphincter in the long-term outcome of medical and surgical treatment for gastroesophageal reflux disease. Nonrandomized control study (median follow-up, 33 months). Referred care. Fifty-five patients with gastroesophageal reflux disease were prospectively evaluated using a symptom questionnaire, upper endoscopy, esophageal manometry, and 24-hour pH monitoring. Patients were classified into three groups: (1) those with a manometrically defective lower esophageal sphincter, treated surgically; (2) those with a manometrically defective lower esophageal sphincter, treated medically; and (3) those with a manometrically normal lower esophageal sphincter, treated medically. Nissen antireflux procedure and medical therapy with H2-blockers and/or omeprazole. Symptomatic improvement after treatment and need for continuous medication. After therapy, symptoms improved significantly in all three groups (P < .05), but least in the patients who declined surgery. Among patients with a defective lower esophageal sphincter, medical therapy could be discontinued in 13 of 14 patients who had surgery compared with one of 14 who declined surgery. Of the 27 patients with a normal lower esophageal sphincter who were treated medically, medical therapy could be discontinued in 12. In patients with gastroesophageal reflux disease who have a defective lower esophageal sphincter, surgery can ensure durable symptom control. Patients with a defective sphincter who decline surgery are destined for lifelong therapy, whereas in approximately half of those with a normal sphincter, medical therapy can eventually be discontinued.