[Role of esophageal motility abnormalities in severe reflux esophagitis]

To evaluate the effects of prolonged treatment with proton pump inhibitor (PPI) on esophageal motility function in patients with severe erosive esophagitis associated with peristaltic dysfunction.

Twelve controls and 70 patients with gastroesophageal reflux disease (GERD) divided into two groups according to endoscopic finding (Los Angeles classification): 27 patients with non-erosive reflux disease (NERD), and 43 with reflux esophagitis (RE) (LA-CD severe esophagitis). They all underwent an ambulatory 24 h pH monitoring and esophageal manometry. Twenty-three patients with severe eosphgitis included in the study with PPI. They all have pathological acid reflux and esophageal peristaltic dysfunction. They were treated with lansoprazole 30 mg per day for three to six months until complete endoscopic healing was achieved. After healing, a control esophageal manometry was then performed.

(1) Esophageal dysmotility occur in every group of GERD, The rates of esophageal dysmotility showed in RE high than NERD (P < 0.05). (2) In PPI group, Before treatment, mean value contraction amplitude was significantly lower than mean contraction amplitude of control group (P < 0.01), as well as mean percentage of peristaltic contractions (P < 0.01). At the end of treatment, no a statistically significant improvement of esophageal motility functions was observed for mean value lower esophageal sphincter pressure [(6.00 +/- 0.86) mm Hg vs. (5.10 +/- 0.87) mm Hg, 1 kPa = 7.5 mm Hg, P = 0.476], mean value contraction amplitude [(34.1 +/- 4.1) mm Hg vs. (37.2 +/- 4.0) mm Hg, P = 0.593] and peristaltic contractions [(33.5 +/- 6.5)% vs. (38.6 +/- 7.1)%, P = 0.592]. The post treatment values were still significantly lower than control values.

This study suggests that both of dysmotility and acid reflux are important role in the mechanism of GERD, especially in severe patients.