OBJECTIVE: To evaluate the clinical role of a defective lower esophageal sphincter in the long-term outcome of medical and surgical treatment for gastroesophageal reflux disease. DESIGN: Nonrandomized control study (median follow-up, 33 months). SETTING: Referred care. PATIENTS: Fifty-five patients with gastroesophageal reflux disease were prospectively evaluated using a symptom questionnaire, upper endoscopy, esophageal manometry, and 24-hour pH monitoring. Patients were classified into three groups: (1) those with a manometrically defective lower esophageal sphincter, treated surgically; (2) those with a manometrically defective lower esophageal sphincter, treated medically; and (3) those with a manometrically normal lower esophageal sphincter, treated medically. INTERVENTION: Nissen antireflux procedure and medical therapy with H2-blockers and/or omeprazole. MAIN OUTCOME MEASURES: Symptomatic improvement after treatment and need for continuous medication. RESULTS: After therapy, symptoms improved significantly in all three groups (P < .05), but least in the patients who declined surgery. Among patients with a defective lower esophageal sphincter, medical therapy could be discontinued in 13 of 14 patients who had surgery compared with one of 14 who declined surgery. Of the 27 patients with a normal lower esophageal sphincter who were treated medically, medical therapy could be discontinued in 12. CONCLUSIONS: In patients with gastroesophageal reflux disease who have a defective lower esophageal sphincter, surgery can ensure durable symptom control. Patients with a defective sphincter who decline surgery are destined for lifelong therapy, whereas in approximately half of those with a normal sphincter, medical therapy can eventually be discontinued.
OBJECTIVE: To evaluate the clinical role of a defective lower esophageal sphincter in the long-term outcome of medical and surgical treatment for gastroesophageal reflux disease. DESIGN: Nonrandomized control study (median follow-up, 33 months). SETTING: Referred care. PATIENTS: Fifty-five patients with gastroesophageal reflux disease were prospectively evaluated using a symptom questionnaire, upper endoscopy, esophageal manometry, and 24-hour pH monitoring. Patients were classified into three groups: (1) those with a manometrically defective lower esophageal sphincter, treated surgically; (2) those with a manometrically defective lower esophageal sphincter, treated medically; and (3) those with a manometrically normal lower esophageal sphincter, treated medically. INTERVENTION: Nissen antireflux procedure and medical therapy with H2-blockers and/or omeprazole. MAIN OUTCOME MEASURES: Symptomatic improvement after treatment and need for continuous medication. RESULTS: After therapy, symptoms improved significantly in all three groups (P < .05), but least in the patients who declined surgery. Among patients with a defective lower esophageal sphincter, medical therapy could be discontinued in 13 of 14 patients who had surgery compared with one of 14 who declined surgery. Of the 27 patients with a normal lower esophageal sphincter who were treated medically, medical therapy could be discontinued in 12. CONCLUSIONS: In patients with gastroesophageal reflux disease who have a defective lower esophageal sphincter, surgery can ensure durable symptom control. Patients with a defective sphincter who decline surgery are destined for lifelong therapy, whereas in approximately half of those with a normal sphincter, medical therapy can eventually be discontinued.
Authors: G M Campos; J H Peters; T R DeMeester; S Oberg; P F Crookes; S Tan; S R DeMeester; J A Hagen; C G Bremner Journal: J Gastrointest Surg Date: 1999 May-Jun Impact factor: 3.452
Authors: Guilherme M R Campos; Stefan Oberg; Otavio Gastal; Jorg Theisen; John J Nigro; Jeffrey A Hagen; Mario Costantini; Cedric G Bremner; Tom R DeMeester; Peter F Crookes Journal: Dig Dis Sci Date: 2003-06 Impact factor: 3.199
Authors: R J Mason; S Oberg; C G Bremner; J H Peters; M Gadenstätter; M Ritter; T R DeMeester Journal: J Gastrointest Surg Date: 1998 Jul-Aug Impact factor: 3.452
Authors: Robert E Marsh; Christopher L Perdue; Ziad T Awad; Patrice Watson; Mohamed Selima; Richard E Davis; Charles J Filipi Journal: World J Gastroenterol Date: 2003-01 Impact factor: 5.742
Authors: Sarah M Cowgill; Mark Bloomston; Sam Al-Saadi; Desiree Villadolid; Alexander S Rosemurgy Journal: J Gastrointest Surg Date: 2007-06 Impact factor: 3.267