Does surgery correct esophageal motor dysfunction in gastroesophageal reflux

Area of Science:

• Gastroenterology
• Esophageal Physiology
• Surgical Innovation

Background:

• Symptomatic gastroesophageal reflux (GER) without peptic stricture often indicates underlying esophageal motor dysfunction.
• Conventional diagnostic methods may fail to identify this dysfunction.
• Radionuclide transit (RT) offers a novel approach to assess esophageal motor function.

Purpose of the Study:

• To prospectively evaluate esophageal motor function in patients with symptomatic GER using radionuclide transit (RT).
• To assess the impact of antireflux surgery (HILL procedure) on esophageal motor function and dysphagia.
• To determine if esophageal motor dysfunction contraindicates successful surgical outcomes.

Main Methods:

• Prospective study of 29 patients with symptomatic GER undergoing HILL procedure.
• Preoperative and postoperative assessment using radionuclide transit (RT) and lower esophageal sphincter pressure (LESP) measurements.
• Intraoperative LESP adjustment to 45-55 mmHg.

Main Results:

• Preoperative dysphagia and esophageal dysfunction were present in 73% and 52% of patients, respectively.
• Postoperative studies showed persistent esophageal dysfunction in 20 patients, despite resolution of dysphagia.
• Successful antireflux surgery effectively controlled reflux symptoms, irrespective of persistent motor dysfunction.

Conclusions:

• Radionuclide transit (RT) identifies esophageal motor dysfunction in a significant portion of symptomatic GER patients.
• Esophageal motor dysfunction is not a contraindication for successful antireflux surgery.
• Effective surgical correction of reflux symptoms can be achieved even with impaired esophageal transit.