L.F. Martinez de Haro

Conservative treatment versus antireflux surgery in Barrett's oesophagus: long-term results of a prospective study.

The results obtained for the treatment of 59 patients diagnosed with Barretts oesophagus, randomized to receive medical treatment (n = 27) or antireflux surgery (n = 32) were assessed prospectively. Median follow‐up for the patients undergoing medical treatment was 4 (range 1–11) years and for patients undergoing surgical treatment 5 (range 1–11) years. Satisfactory symptomatic control (excellent to good results) was achieved in 24 patients after medical therapy and in 29 after antireflux surgery. The proportion of patients with persistent inflammatory lesions (54 per cent) and persistent or recurrent stenosis (47 per cent) was significantly higher after conservative treatment than after surgery (5 and 15 per cent, respectively). A decrease in the length of the segment of columnar mucosa was observed in eight of the patients who underwent antireflux surgery, and in only two of those given medical therapy. Conversely, an upward progression of the columnar lining was more frequent in the latter group (11 versus three). Mild dysplasia was observed in five patients, all from the group undergoing medical treatment. Severe dysplasia was detected in two patients, one undergoing medical treatment and the other following surgical therapy, in whom an antireflux procedure had failed previously. Both patients underwent oesophageal resection, with confirmation of a carcinoma in situ. The patients in whom antireflux surgery proved effective showed no dysplastic change or progression to adenocarcinoma. These results, despite the small number of patients and methodological limitations, question the systematic conservative approach in the initial management of patients with Barretts oesophagus.

Ineffective oesophageal motility does not affect the clinical outcome of open Nissen fundoplication

Nissen fundoplication is considered the ‘gold standard’ in antireflux surgery but some surgeons employ a different surgical strategy when gastro‐oesophageal reflux disease (GORD) is associated with motor disorders of the oesophageal body.

Antireflux mechanism of nissen fundoplication : a manometric study

To analyze the mechanisms by which Nissen fundoplication controls gastroesophageal reflux, the pre-and post-operative manometric findings in 34 patients were compared. The postoperative assessment showed an increase in both the infradiaphragmatic length and basal pressure of the lower esophageal sphincter and a notable improvement in esophageal motility (increase in the amplitude of the waves and decrease in the mean percentage of deglutitions without response and tertiary waves) in those who preoperatively presented with defective esophageal peristalsis.

Can pH Recordings Suggest Defective Esophageal Peristalsis in Patients with Gastroesophageal Reflux

The data provided by 24-h pH monitoring in 40 patients with gastroesophageal reflux, divided in three groups in accordance with esophageal motor pattern, were compared. Patients with hypomotility had significantly greater reflux rates than those with normal motility or hypermotility, if we consider both total time with pH < 4 and time with pH < 4 corresponding to episodes of > 5 min duration. We conclude that when 24-h pH monitoring shows very high reflux rates, basically corresponding to episodes lasting > 5 min, we should suspect the presence of defective esophageal peristalsis, which must be confirmed with a manometric study.

Funduplicatura de Nissen por laparoscopia como técnica de elección para el tratamiento de la enfermedad por reflujo gastroesofágico

Resumen Introduccion y objetivos Pretendemos corroborar, mediante la aportacion de nuestros resultados y la comparacion de los datos manometricos y pHmetricos, pre y postoperatorios, que la funduplicatura de Nissen por via laparoscopica es la tecnica de eleccion para el tratamiento de la enfermedad por reflujo gastroesofagico (ERGE), obteniendose resultados similares a los de la cirugia convencional. Material y metodos Un total de 72 pacientes, intervenidos consecutivamente, afectados de ERGE, 54 varones y 18 mujeres, con una edad media de 42 anos. Todos presentaban clinica de ERGE, con una media de evolucion de 5 anos y habian recibido tratamiento medico correcto durante una media de 24 meses. El estudio preoperatorio incluyo: esofagogastroduodenoscopia, TEGD, pHmetria de 24 h y manometria esofagica. La tecnica quirurgica practicada fue una funduplicatura de Nissen por via laparoscopica. En el control postoperatorio se realizaron: esofagogastroduodenoscopia, pHmetria de 24 h y manometria esofagica, valorandose el grado de satisfaccion mediante la escala de Visick. Los datos obtenidos se compararon estadisticamente mediante el test de la t de Student apareada y el test de Wilcoxon. Resultados La pHmetria preoperatoria revelo una media de porcentaje de tiempo de pH Conclusiones Tras una experiencia de cuatro anos y medio en funduplicatura de Nissen por laparoscopia, y a la vista de los resultados obtenidos, pensamos que es la tecnica quirurgica de eleccion para el tratamiento de la ERGE.

Assessment of Gastroesophageal Reflux following Heller’s Myotomy Associated with a 270° Posterior Partial Fundoplication

By means of clinical, endoscopic, manometric and pH metric studies, the incidence of gastroesophageal reflux in 30 patients with achalasia of the cardia was evaluated at least 5 years after undergoing