The effect of medical therapy and antireflux surgery on dysphagia in patients with gastroesophageal reflux disease without esophageal stricture

Autor: Ronald A. Hinder, Gerold J. Wetscher, Michael Gadenstaetter, Karl Glaser, Christoph Profanter
Rok vydání: 1999
Předmět:
Male
medicine.medical_treatment
Fundoplication
Nissen fundoplication
Gastroenterology
2-Pyridinylmethylsulfinylbenzimidazoles
Heartburn
Surveys and Questionnaires
Prospective Studies
Enzyme Inhibitors
Pantoprazole
Cisapride
General Medicine
Hydrogen-Ion Concentration
Middle Aged
Dysphagia
Treatment Outcome
medicine.anatomical_structure
Sulfoxides
Esophageal stricture
Esophageal Stenosis
Gastroesophageal Reflux
Drug Therapy
Combination
Female
medicine.symptom
Omeprazole
medicine.drug
Adult
medicine.medical_specialty
Manometry
Internal medicine
Pressure
otorhinolaryngologic diseases
medicine
Humans
Esophagus
Aged
Esophageal disease
business.industry
Proton Pump Inhibitors
Anti-Ulcer Agents
medicine.disease
digestive system diseases
Surgery
GERD
Benzimidazoles
Laparoscopy
Deglutition Disorders
business
Follow-Up Studies
Zdroj: The American Journal of Surgery. 177:189-192
ISSN: 0002-9610
DOI: 10.1016/s0002-9610(99)00011-2
Popis: BACKGROUND: Poor esophageal body motility and trapping of the hernial sac by the hiatal crura are the major pathomechanisms of gastroesophageal reflux disease (GERD)-induced dysphagia. There is only little knowledge of the effect of medical therapy or antireflux surgery in reflux-induced dysphagia. METHODS: Fifty-nine consecutive GERD patients with dysphagia were studied by means of a symptom questionnaire, endoscopy, barium swallow, esophageal manometry, and 24-hour pH monitoring of the esophagus. Patients had proton pump inhibitor therapy and cisapride for 6 months. After GERD relapsed following withdrawal of medical therapy, 41 patients decided to have antireflux surgery performed. The laparoscopic Nissen fundoplication was chosen in 12 patients with normal esophageal body motility and the laparoscopic Toupet fundoplication in 29 patients with impaired peristalsis. Dysphagia was assessed prior to treatment, at 6 months of medical therapy, and at 6 months after surgery. RESULTS: Heartburn and esophagitis were effectively treated by medical and surgical therapy. Only surgery improved regurgitation. Dysphagia improved in all patients following surgery but only in 16 patients (27.1%) following medical therapy. Esophageal peristalsis was strengthened following antireflux surgery. CONCLUSIONS: Medical therapy fails to control gastroesophageal reflux as it does not inhibit regurgitation. Thus, it has little effect on reflux-induced dysphagia. Surgery controls reflux and improves esophageal peristalsis. This may contribute to its superiority over medical therapy in the treatment of GERD-induced dysphagia.
Databáze: OpenAIRE
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