Society for Surgery of the Alimentary Tract

2005 Abstracts: Connective Tissue Disorders and Gastroesophageal Disease: Role of Esophageal Function Tests

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Connective Tissue Disorders and Gastroesophageal Disease: Role of Esophageal Function Tests
Tanuja Damani, Pietro Tedesco, Adam T. Meneghetti, Marco G. Patti, UCSF Medical Center, San Francisco, CA

Background: When a patient with a connective tissue disorder (CTD) experiences heartburn, it is assumed that gastroesophageal disease (GERD) is present and that esophageal function tests (manometry and 24-hour pH monitoring) are seldom done to confirm the diagnosis. Because it is assumed that the disease impairs esophageal peristalsis, a fundoplication is rarely considered for fear of causing dysphagia, and acid suppressing medications are commonly prescribed.

Aim: The aims of this study were to determine in patients with CTD: (a) the sensitivity of symptoms in the diagnosis of GERD; (b) the role of esophageal function tests in establishing the diagnosis of GERD; and (c) the manometric and reflux profile. Methods: Between October 1996 and October 2004, 28 patients with CTD and a clinical diagnosis of GERD, underwent esophageal function testing. All patients had been treated with acid suppressing medications for an average of 50 months. Results: Based on the results of 24-hour pH monitoring, patients were divided into two groups: Group A, 21 patients (75%), GERD+; and Group B, 7 patients (25%), GERD-.

	Group A (GERD+)	Group B (GERD-)	p-value
Age (years)	50�12	50�11	NS
Duration of symptoms (months)	76+83	38+40	NS
Heartburn (% pts)	71	43	NS
Medications (% pts)	86	71	NS
LES pressure (mmHg)	14.3�8.7	20.2�5.7	NS
Distal Esophageal Amplitude (mmHg)	83�52	104�61	NS
Ineffective Esophageal Motility (% pts)	33	28	NS
Total % time pH <4 (5 cm above LES)	19.5�10	1.7�1.6	0.001
Total % time pH <4 (20 cm aboveLES)	4.2�5.3	0.2�0.3	0.05

LES = Lower Esophageal Sphincter Conclusions: These data show that in patients with CTD: (a) symptoms were unreliable in diagnosing GERD; (b) 24-hour pH monitoring identified patients with GERD, and stratified them according to the severity of the disease;(c) proximal gastroesophageal reflux was frequently found; (d) esophageal peristalsis was preserved in every patient regardless of the duration of symptoms. Thus, a laparoscopic fundoplication should be considered in patients with CTD, particularly when respiratory symptoms are present.

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