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Background: Abnormal esophageal motility is frequent in Barrett's esophagus (BE); isn't yet clear if is a primary abnormality or a consequence of injury. Non-propagated contractions, simultaneous or low amplitude contractions compromise esophageal clearance. That suggests extension of the inflammatory process to the muscle layer, affecting esophageal motility. Surgical treatment would decrease the inflammation of the esophageal mucosa improving the change in esophageal motor function.
Objective: Access the effect of antireflux surgery on esophageal motility in patients with Barrett's esophagus with esophageal motility disorder.
Methods: We evaluated 20 consecutive Barrett's patients operated with esophageal dismotility. Inclusion criteria were: 12 months of minimum follow-up, asymptomatic patients out of PPIs, with endoscopy study without esophagitis and topic fundoplication.
Results: Thirteen patients were male (65%), the mean age was 54.95 (± 3.53) years, the lenght of Barrett esophagus was 3.7 (± 0.56). Follow-up was 76.2 (±9.27) months in average. The 24-hour pH monitoring after antireflux surgery showed a significant reduction or absence acid reflux (p<0.01). Before surgery the manometric evaluation showed 17 patients (85%) with LES hypotonia, 12 patients (60%) had esophageal body hypocontractility, two patients (10%) had nutcracker esophagus and four patients (20%) had abnormal esophageal peristalsis (IEM). There was an increase in the LESRP compared with preoperative values in 70% of the patients, the mean LESRP was 10.99 (± 1.92) before and 14.93 (± 1.33) after ARS (p 0.024). After ARS 40% of patients with hypocontractility showed an increase in amplitude of the peristaltic contractions in distal esophagus and thease, 30% returned to normal values; both patients with nutcracker esophagus have normalised contraction amplitude (p = 0.021).
Five patients (25%) showed worsening of contraction amplitude and 15% remained with severe hypocontractility. Four patients (20%) who had normal esophageal peristalsis before ARS evoluated with aperistalsis or IEM after ARS. Three patients (15%) with abnormal esophageal peristalsis showed improvement and normalized the esoophageal peristalsis (p=0.201).
Conclusion: At least 50% of patients with BE with impaired esophageal motility who underwent surgery had improvement of the esophageal motility disoderes, 40% reached normal values and patients with nutcracker esophagus showed normalization of contractility.