[Prospective evaluation of gastroesophageal reflux in patients with achalasia treated with pneumatic dilatation, thoracic or abdominal myotomy].
BACKGROUND
Symptomatic gastroesophageal reflux (GER) occurs in 0-20% of patients treated with pneumatic dilation and in 5-30% with cardiomyotomy. However, the prevalence of GER evaluated with esophageal pH-monitoring is unknown.


OBJECTIVE
To investigate the frequency of GER in achalasia patients treated with pneumatic dilation or myotomy.


METHODS
Patients with achalasia were evaluated prospectively and classified in 4 groups: group A = treated with pneumatic dilation; group B = treated with open abdominal myotomy; group C = transthoracic myotomy; and group D = submitted to laparoscopic abdominal myotomy with antireflux procedure. Esophageal manometry and 24 h pH-monitoring were performed in all patients. GER was defined as a pH < 4 in more than 4% of the total time.


RESULTS
Thirty-one patients, 22 women and 9 men, with a mean age of 44.7 years were evaluated. Nine patients had GER symptoms and 22 were asymptomatic. GER was detected with pH-metry in 42% of the total group: 33% for group A, 75% for group B, 44% for group C and none for group D.


CONCLUSIONS
Prevalence of GER in achalasia patients treated with pneumatic dilation and surgical myotomy was high. We suggest the inclusion of 24 hr esophageal pH-metry in the follow-up due to the significant prevalence of asymptomatic GER. Minimal hiatus dissection and antireflux procedure were surgical factors related with a lower frequency of GER after achalasia myotomy.
Aguilar-Paiz
L A
LA
Laboratorio de Motilidad Gastrointestinal, Instituto Nacional de la Nutrición Salvador Zubirán (INNSZ), México, D.F.
Valdovinos-Díaz
M A
MA
Flores-Soto
C
C
Carmona-Sánchez
R
R
Vargas-Vorácková
F
F
Herrera
M F
MF
de la Garza-Villaseñor
L
L
Hernández
M F
MF
D000328:Adult; D000368:Aged; D002404:Catheterization; D004931:Esophageal Achalasia / Q000601:surgery / Q000628:therapy*; D005260:Female; D005764:Gastroesophageal Reflux / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies