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Esophageal Mucosal Damage Promotes Dysmotility and Worsens Esophageal Acid Exposure
Adam T. Meneghetti, Pietro Tedesco, Tanuja Damani, Marco Patti, UCSF Medical Center, San Francisco, CA

Aim: To determine in patients with gastroesophageal reflux disease (GERD) the relationship between esophageal mucosal injury, esophageal dysmotility, and esophageal acid exposure.

Design: University hospital tertiary care center. Setting: Retrospective study from a prospectively collected database. Methods: Eight hundred and twenty seven patients with GERD (by barium swallow, endoscopy (EGD), manometry and 24-hour pH monitoring), were divided into three groups based on the degree of mucosal injury: group A, no esophagitis, 493 patients; group B, esophagitis grade I-III, 273 patients; and group C, Barrett's esophagus, 61 patients. Results: Data are expressed as median values:

	Group A	Group B	Group C
Duration of symptoms (months)	48	60	72§
LES pressure (mmHg)	12Y	10	8§
DEA (mmHg)	67	64	47§
% Patients with IEM	13Y	23*	43§
% Time pH < 4	9Y	11*	16§
# Reflux Episodes > 5 minutes	4Y	5*	11§
Reflux score (normal < 14.7 )	39Y	49*	65§

IEM=Ineffective esophageal motility  DEA=Distal esophageal amplitude LES=Lower esophageal sphincter § = A vs. C p < 0.05 Y = A vs. B p < 0.05 *= B vs. C p < 0.05 Conclusions: In patients with GERD, worsening of esophageal mucosal injury determines progressive deterioration of esophageal motor function with impairment of acid clearance and increase of esophageal acid exposure. These findings demonstrate that Barrett's esophagus is an end stage form of GERD, and suggest that surgical therapy should be favored at an early stage in the course of the disease to block this cascade of events.

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