[Functional studies of the esophagus in gastroesophageal reflux: application to anti-reflux surgery]

A functional exploration of the esophagus, an acid reflux test, a manometry and an endoscopic examination were performed on 56 patients in succession, who had undergone a complete fundoplication for gastro-esophageal reflux. These tests were done pre-operatively as well as post-operatively at short term (1 year) and long term (4 years). The functional and endoscopic pre-operative work-up did not enable to isolate a group of patients likely to present a therapeutic failure. 54 patients were seen again at 1 year, with a good clinical result in 50 of them (92 per cent). At 4 years, 39 out of 48 patients (81 per cent) maintained that result. The acid reflux test was abnormal in all cases of clinical recurrence. Two asymptomatic patients had an abnormal test. One presented a clinical recurrence subsequently, the other had a severe esophagitis confirming the recurrence. On manometry, a significant and stable increase of the pressure of the lower esophageal sphincter was noticed after fundoplication (8.1 +/- 1.8 mmHg pre-operatively, 15.5 +/- 1.4 mmHg at 1 year, 14.5 +/- 1.5 mmHg at 4 years). In case of recurrence, the pressures were in an average lower although values within normal limits could not exclude a recurrence. A complete fundoplication is therefore a reliable long term procedure. The functional exploration of the esophagus post-operatively enables to select asymptomatic patients with a high recurrence risk and gives an objective evaluation of the operative results.