Abstracts
2000 Digestive Disease Week

# 2261 Esophageal Body Function in Patients with Paraesophageal Hernia Is Similar to Those with Gastroesophageal Reflux Disease.
Stephen B. Archer, C. Daniel Smith, Gene Branum, Kathy Galloway, Patrick Waring, John G Hunter, Atlanta, GA

Background: Studies describing esophageal motility patterns in patients with paraesophageal hernia (PH) usually report a high rate of disordered or inadequate esophageal body function. Our aim was to compare preoperative motility studies (EMS) in patients with PH to those with gastroesophageal reflux disease (GERD), but without PH. A second aim was to determine how EMS influenced operative procedure and postoperative outcome in PH and GERD patients. Methods: Comparison was made of preoperative EMS in patients undergoing either PH repair with fundoplication [FN], or FN for GERD between 12/ 92 and 10/99. Patients undergoing redo operations, those with Barret’s esophagus, or esophageal stricture were excluded. Motility was considered abnormal if esophageal body pressure was less than 40mmHg or if normal propagation occured in less than 60% of wet swallows. Postoperative subjective dysphagia scores (0 [none]-3[severe]) were compared between PH and GERD patients. Results: Esophageal dysmotility was found with equal frequency in patients with PH and in patients with GERD (see table). Complete (360o) FN was used in 92% of patients with GERD and in 83% of PH patients. Partial FN was performed in the remainder. Conclusions: Depsite advance age at presentation, impaired motility is no more common in patients with PH than in patients with GERD. Frequency of severe dysphagia is similar for the two groups, suggesting that fundoplication tailored to preoperative EMS provides excellent outcomes in patients with PH and GERD.