[Postoperative evaluation of esophageal mucosal change dynamics in patients with reflux diseases]

Comparative value of esophagoscopy and biopsy in correlation with 24 hour esophageal pH metry parameters were assessed in 53 consecutive patients operated on due to GERD. The special attention was paid to the type and intensity of esophageal mucosa injury and the quantity of the pathological gastroesophageal reflux. The therapeutic effect of the Nissen Rossetti fundoplication on postoperative changes in esophageal mucosa was also estimated on the average 18 months after the antireflux procedure. Pre and postoperative efficiency of the antireflux mechanism and patients conditions were evaluated on the grounds of anamnesis, physical examination, x-ray examination, endoscopy with biopsy, 24 hours pH metry, LES and body of the esophagus manometry. The results were shown as mean and standard deviation. Statistical significance was determined using SPSS/PC-packet, Smirnow-Kolmogorow and Wilcoxon test, with p values < 0.05 considered as significant. After the operation complete and durable relief of reflux symptoms was obtained in 83% patients, with high significant decrease of DeMeester score from 21.15 +/- 12.19 to 3.43 +/- 5.22, p < 0.0002. Endoscopy following the operation confirmed significant regression of the GERD pathology, mainly in II and III degree according to Savary Miller classification, from 98.1% to 18.9%, p < 0.005. In comparison with other types of the pathology, Barrett's esophagus was always connected with significant higher quantity of the pathological gastroesophageal reflux before as well as after the operation. Biopsy following the operation revealed not significant regression of mucosal GERD lesions in 54.7%. The healing changes were observed first of all in the most severe esophageal injuries-chronic squamous esophagitis (64%), CLE except intestinal type of metaplasia (86.&%) and low grade dysplasia of squamous epithelium (100%). The absence of regression after the operation was always combined with unsatisfactory decrease of 24 hour pH metry parameters: DeMeester score, percentage of total time pH < 4.0 and time pH < 4.0 in supine position. Postoperative progression of GERD pathology was noticed in 12.6% patients. One third patients had the same biopsy outcome before and after the operation, even in those without any GERD complaints. Biopsy in correlation with 24 hour pH metry analysis similarly like endoscopy revealed in CLE twice higher DeMeester score than squamous esophagitis, hyperplasia or normal esophageal mucosa. The study proved that more advanced stages of GERD pathology were connected with higher quantity of the gastroesophageal reflux. The results presented in this study confirmed high efficacy of the Nissen Rossetti fundoplication in surgical treatment of GERD. We would to emphasize that with unsatisfactory biopsy results following the operation should be the reason for permanent follow up endoscopic and histopathologic verification.