[The role of esophageal manometry in the management of the patients with gastro-esophageal reflux disease and Barrett's esophagus].
OBJECTIVE
To analyze the correlation between the failure of medical treatment in patients with reflux esophagitis or Barrett esophagus and LES function, manometrically measured.


METHODS
This is a prospective study of 24 patients admitted in our clinic for reflux disease symptoms, who were investigated by endoscopy (combined with biopsy), esophageal manometry and 24 h pH monitoring. The including criteria for the patients was abnormal esophageal exposure to acid reflux, each patient having abnormal 24 h pH monitoring (pH < 4 in the esophagus more then 4.4% in 24 h). Each patient received medical treatment with clinic and endoscopic reevaluation after 3 months.


RESULTS
From the 24 patients that were included: 4 patients having Barrett esophagus, 13 patients with esophagitis (3 patients associated complications such as ulcer or esophageal stenosis) and 7 patients without visible lesions on endoscopy. From the 24 patients, 11 patients presented an incompetent LES, characterized by the following values obtained by manometry: total length < or = 2 cm, abdominal length < or = 1 cm, mean pressure: < 6 mmHg. There were 2 patients from the 4 having Barrett esophagus that presented an incompetent LES, and also the 3 patients having esophagitis associated with complications. All patients were reevaluated clinically and endoscopically after 3 months of medical treatment with PPI 40 mg/day. From the 11 patients with incompetent LES, 5 patients had symptoms or modifications on endoscopy, whereas from 13 patients with a competent LES only one patient presented with symptoms of reflux disease.


CONCLUSIONS
The presence of an incompetent LES may be a cause of a poor response to medical treatment and may also be an element for taking into consideration surgical treatment.
Hoară
P
P
Clinica de Chirurgie Generală si Esofagiană, Spitalul Clinic Sf. Maria, Bucureşti. petre_hoara@yahoo.com
Bîrlă
R
R
Gîndea
C
C
Constantin
A
A
Panaitescu
G
G
Iordan
N
N
Constantinoiu
S
S
D001471:Barrett Esophagus / Q000150:complications / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology*; D050782:Esophageal pH Monitoring; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D016896:Treatment Outcome
D054328:Proton Pump Inhibitors