Macroscopic healing of esophagitis does not improve esophageal motility

Abstract

The purpose of the present study was to prospectively determine if healing of esophagitis as assessed by endoscopy results in improved esophageal motility. Thirty-one patients with erosive esophagitis who were randomized to receive either omeprazole 20 mg once daily or placebo completed the double-blind study. All patients underwent endoscopy and esophageal motility before treatment and at four weeks after treatment. Twenty-two healthy volunteers underwent esophageal manometry and served as normal controls. Manometric tracings were coded, randomized, and analyzed blindly. Compared to normal controls, patients with esophagitis had significantly lower LESP, decreased amplitude of peristaltic contractions, and increased occurrence of abnormal contractions. Omeprazole was superior to placebo in healing of esophagitis. However, healing of esophagitis was not associated with any improvement in esophageal motility. The manometric data suggest that the motility disturbance seen in esophagitis is not secondary to the esophagitis but rather a primary phenomenon. The lack of improvement of esophageal motility with healing may explain the high recurrence of esophagitis in clinical trials following discontinuation of omeprazole.

The Spectrum of Motor Function Abnormalities in Gastroesophageal Reflux Disease and Barrett’s Esophagus

“…Nevertheless, such improvement in LES pressure may simply represent the effects of the artificial high-pressure zone that was created around the LES by fundoplication, and which persists during both transient and swallow-induced LES relaxation [62]. On the other hand, large studies did not show that healing of esophagitis with either histamine type-2 receptor antagonists or proton pump inhibitors affected LES pressure or esophageal peristaltic contractions [63,64,65,66,67]. Paired esophageal motility evaluation in 41 patients prior to and after photodynamic therapy for Barrett’s high-grade dysplasia or esophageal adenocarcinoma revealed abnormal esophageal motility in 14 patients at baseline (3 patients with diffuse esophageal spasm, 7 with IEM and 4 with aperistalsis).…”

Laparoscopic Nissen fundoplication is a good option in patients with abnormal esophageal motility

“…The medical treatment of these patients has inconsistent results in improving esophageal dysmotility [3,4]. In contrast, surgical series suggest that fundoplication improves IEM in GERD [5][6][7].…”

Importance of ineffective esophageal motility in patients with erosive reflux disease on the long-term outcome of Nissen fundoplication

“…It has been documented that motility recovery does not occur in GERD patients in whom reflux esophagitis is treated and cured with PPI [37][38][39]. It also seems that hiatal hernia and prolonged esophagitis strongly affect each other, which in an extended period of time starts to impair esophageal motility [40].…”