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Related Experiment Videos

Reflux patterns in patients with achalasia without operation.

J P Shoenut1, B G Trenholm, A B Micflikier

  • 1Department of Medicine, St. Boniface General Hospital, Winnipeg, Man, Canada.

The Annals of Thoracic Surgery
|March 1, 1988
PubMed
Summary

Preoperative esophageal pH monitoring in achalasia patients helps assess reflux patterns. This information can guide surgical decisions, potentially improving outcomes for individuals with this esophageal motility disorder.

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Area of Science:

  • Gastroenterology
  • Esophageal Physiology
  • Surgical Assessment

Background:

  • Achalasia is a primary esophageal motility disorder characterized by impaired relaxation of the lower esophageal sphincter (LES) and loss of peristalsis.
  • Esophageal reflux is a potential complication or co-existing condition in achalasia patients, impacting surgical planning and outcomes.
  • Preoperative evaluation is crucial for determining the optimal surgical approach in achalasia management.

Purpose of the Study:

  • To investigate the pattern and extent of esophageal reflux in achalasia patients who have not undergone prior surgery.
  • To evaluate the utility of 24-hour ambulatory esophageal pH monitoring in the preoperative assessment of achalasia.
  • To determine if reflux indices correlate with LES pressure, position, or length in this patient cohort.

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Main Methods:

  • Esophageal manometry was performed on five treatment-naïve achalasia patients.
  • 24-hour ambulatory esophageal pH monitoring was conducted to quantify reflux episodes and duration.
  • Analysis included assessment of reflux in relation to patient position (supine vs. upright) and LES parameters.

Main Results:

  • One patient exhibited reflux within normal limits.
  • Two patients showed minimal reflux (0.5% total time) with no supine reflux.
  • Two patients demonstrated significant reflux (16.8% and 55.3% total time), predominantly during supine periods. Reflux indices were independent of LES tone, position, or length.

Conclusions:

  • 24-hour esophageal pH monitoring is a valuable tool for preoperative assessment in achalasia patients.
  • Identifying significant esophageal reflux, particularly supine reflux, can inform surgical strategy.
  • The findings suggest that pH monitoring data may influence the choice of operative procedure for achalasia.