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Functional Assessment, Proposed Pathogenesis, and Surgical Therapy

Clemente Iascone, MD; Tom R. DeMeester, MD; Alex G. Little, MD; David B. Skinner, MD

Arch Surg. 1983;118(5):543-549.

Abstract
• Esophageal function was assessed with manometry and 24-hour pH monitoring of the distal esophagus in 22 patients with histologically proven Barrett's esophagus (BE), 31 consecutive patients with endoscopic grade 2 or 3 esophagitis, and 33 normal volunteers. Patients with BE had less lower esophageal sphincter (LES) pressure, but similar length of sphincter exposed to the abdomen, than patients with esophagitis. Both groups had significantly less LES pressure and abdominal length than normal subjects. Patients with BE had statistically more esophageal acid exposure than patients with esophagitis, and both differed markedly from normal subjects. They also had a greater number of reflux episodes lasting longer than five minutes than patients with esophagitis, suggesting that the severity of acid exposure was due to a defect in esophageal clearance. The extent of Barrett's mucosal change was related to the level of LES pressure and the number of reflux episodes that were five minutes or longer in duration. We concluded that BE is related to a mechanical incompetency of the cardia and a decrease in esophageal clearance that requires reconstruction of the cardia for effective therapy.

(Arch Surg 1983;118:543-549)

Author Affiliations
From the Department of Surgery, University of Chicago Pritzker School of Medicine.

Footnotes
Accepted for publication Jan 13, 1983.

Read before the 90th annual meeting of the Western Surgical Association, Kansas City, Mo, Nov 15, 1982.

Reprint requests to Department of Surgery, Box 440, University of Chicago, 950 E 59th St, Chicago, IL 60637 (Dr DeMeester).

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