Esophageal clearance function following treatment of esophagitis

To investigate whether healing of the esophagitis was associated with an improvement in esophageal clearance function, 15 patients with endoscopic and histologically confirmed erosive esophagitis were studied both before and after 1-month treatment with 40 mg/day of omeprazole.

All patients were studied before and after treatment by perfusion manometry to measure esophageal pressures, and a traction measuring device was used to record aboral forces generated by graded intraluminal distension.

Before treatment, standard manometry showed reduced lower esophageal sphincter pressures (4 mm Hg [range, 2-9] vs. a control of 12 mm Hg [range, 5-25]; P < 0.01) and distal peristaltic amplitudes (29 mm Hg [range, 5-57] vs. a control of 55 mg Hg [range, 32-90]; P < 0.01). Responses to distension were also abnormal with a higher threshold for induction of contractile activity (12 mL [range, 8.5-14] vs. control values of 5 mL [range, 3-10]; P < 0.01) and weaker clearance forces (5 g [range, 0-80] vs. control values of 20 g [range, 8-90]; P < 0.01). After treatment, all patients showed endoscopic and histological evidence of healing, but not consistent improvement in either lower esophageal sphincter pressure (5 mm Hg [range, 3-7]; P > 0.05 vs. pretreatment) or peristaltic amplitude (35 mm Hg [range, 10-55]) was found. However, responses to distension did improve, with a decrease in distension threshold to 10 mL (range, 7-14; P = 0.04) and enhancement of traction force to 14 g (range, 0-95; P < 0.01). Patients with the worst pretreatment distension responses showed the least improvement with therapy.

Improvement in esophageal clearance can be achieved by the healing of esophagitis, although the capacity for functional benefit appears to be related to the degree of dysfunction present before therapy.