| Impact of endoscopic suturing of the gastroesophageal junction on lower esophageal sphincter function and gastroesophageal reflux in patients with reflux disease. | |
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MedLine Citation:
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PMID: 15046204 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: Plication of the gastroesophageal junction by endoscopic suturing has been reported to improve symptoms and reduce acid exposure in patients with gastroesophageal reflux disease (GERD). The mechanisms underlying these effects are not well defined. The aims of our study were to determine the impact of endoscopic suturing of the gastroesophageal junction on lower esophageal sphincter (LES) function in patients with GERD. METHODS: In 15 patients (7 males) with GERD (heartburn, % time esophageal pH < 4 greater than 4%, +/- history of erosive esophagitis within 6 months), two plications were performed circumferentially 1 cm below the gastroesophageal junction. Endoscopy and combined postprandial esophageal manometry and pH monitoring were performed before and 6 months after treatment; 24-h ambulatory pH monitoring and symptom assessment were also performed before, and at 6 and 12 months after treatment. RESULTS: Six months after treatment, the rate of transient LES relaxations (tLESRs) was decreased by 37% (p < 0.05) and basal LES pressure had increased from 4.3 +/- 2.2 mmHg to 6.2 +/- 2.1 mmHg (p < 0.05). The rate of postprandial reflux events and acid exposure time were not altered. Endoscopic suturing significantly reduced 24-h esophageal acid exposure from 9.6% (9.0-12.1) to 7.4% (3.9-10.1) at 6 months, due predominantly to a reduction in upright acid exposure. The reduction in total 24-h acid exposure was sustained to 12 months. At repeat endoscopy, only one plication was evident in 6 patients (40%) at 6 months. Seven patients (47%) remained off medications at 6 and 12 months follow-up. CONCLUSIONS: In patients with GERD, endoscopic suturing of the gastroesophageal junction results in a reduction in the rate of tLESRs, and an increase in basal LES pressure. These changes in LES function result in only a modest reduction in gastroesophageal reflux. |
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Authors:
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William C E Tam; Richard H Holloway; John Dent; Rachael Rigda; Mark N Schoeman |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: The American journal of gastroenterology Volume: 99 ISSN: 0002-9270 ISO Abbreviation: Am. J. Gastroenterol. Publication Date: 2004 Feb |
Date Detail:
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Created Date: 2004-03-29 Completed Date: 2004-05-06 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0421030 Medline TA: Am J Gastroenterol Country: United States |
Other Details:
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Languages: eng Pagination: 195-202 Citation Subset: IM |
Affiliation:
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Department of Gastroenterology, Hepatology and General Medicine, Royal Adelaide Hospital, Adelaide, South Australia 5000, Australia. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Endoscopy, Digestive System / methods* Esophagogastric Junction / physiopathology*, surgery* Female Gastroesophageal Reflux / diagnosis, physiopathology*, surgery* Humans Hydrogen-Ion Concentration Male Manometry / methods Middle Aged Monitoring, Physiologic / methods Suture Techniques* |
| Comments/Corrections | |
Comment In:
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Am J Gastroenterol. 2004 Feb;99(2):203-4
[PMID:
15046205
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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