Prospective study of esophageal motor abnormalities in patients with gastroesophageal disease reflux according to the severity of endoscopic esophagitis.

BACKGROUND/AIMS: This prospective study evaluates the peristaltic activity of the thoracic esophagus in a group of patients with gastroesophageal reflux disease grouping them according to the endoscopic findings. MATERIALS AND METHODS: The peristaltic activity and the manometric features of the lower esophageal sphincter were prospectively evaluated in 109 controls and 321 patients with reflux esophagitis, divided according to the degree of endoscopic esophagitis employing Savary's classification. RESULTS: Gastro esophageal sphincter pressure was progressively lower according to the severity of the tissue damage. Motor peristaltic activity of the thoracic esophagus measured by several different parameters was significantly altered in Grade IV esophagitis compared to other groups (p < 0.01). The manometric changes were more pronounced at the distal esophagus compared to the proximal esophagus. The percentage of patients with severe motor disturbances, defined as lower esophageal sphincter (LES) pressure less than 6 mm, less than 50% of peristaltic waves after swallowing and amplitude of contractile waves of less than 50 mmHg were significantly greater in patients with severe esophageal injury (p < 0.001). CONCLUSION: Gastroesophageal esophageal reflux may exhibit a wide spectrum of motor disturbances in the distal part of the esophagus even before the presence of the tissue damage, but it increases in proportion to the severity of endoscopic esophagitis.