[Motility disorders of the esophagus after surgery on the stomach]

Oesophagus manometry with a small catheter transducer was performed in 20 patients after total gastrectomy (13 males and 7 females; mean age 60 [35-79] years) and four after partial gastric resection (2 males and 2 females; mean age 70 [60-78] years). All patients were also questioned about any symptoms. Thirteen of the 20 patients reported symptoms of reflux and of abnormal peristalsis (dysphagia, odynophagia). All but one of the 20 patients after total gastrectomy had manometrically abnormal contraction patterns (repetitive, simultaneous, deformed multiple-peak contractions), especially in the distal oesophagus. On average the contractions were diminished by 9 mmHg; resting pressure in the upper oesophagus was reduced by the same amount. These changes were probably due to increased reflux as well as changed biomechanics from the operation (decreased longitudinal tension, absent lower sphincter and postoperative adhesions). The four patients after subtotal resection (with preservation of the lower oesophageal sphincter) had hardly any reflux symptoms, even though the lower sphincter was insufficient in two patients (abdominal compression test), with a corresponding abnormal contraction pattern. Force of contraction in the body of the oesophagus and resting pressures of the two sphincters were also normal.