Healing of severe esophagitis improves esophageal peristaltic dysfunction

Reflux esophagitis is frequently associated with peristaltic dysfunction, which increases with the severity of inflammatory lesions. In order to assess peristaltic dysfunction with more accuracy before and after healing, we used a 24-hr pH and pressure recording method. Nineteen patients (median age: 65, range: 33-77) with stage II and III (Savary-Miller classification) esophagitis and peristaltic dysfunction were treated with 40 mg omeprazole for three to six months until complete endoscopic healing was achieved. Before treatment, median contraction amplitude was significantly lower than median contraction amplitude of a control group of comparable age [31 (21-53) versus 42 (21-77) mm Hg, P < 0.01], as well as median percentage of peristaltic contractions [27 (16-63) versus 44 (11-56), P < 0.01]. At the end of treatment, a statistically significant improvement of esophageal motor functions was observed for both median contraction amplitude [38 (26-55), P = 0.001] and median percentage of peristaltic waves [45 (23-68), P = 0.0001]. The posttreatment values, although still low, were not significantly different from control values. In conclusion, complete healing of grade II and III esophagitis improves peristalsis. Inflammatory processes related to severe esophagitis may be involved in failed peristalsis and low contraction amplitude.