European Journal of Cardio-Thoracic Surgery, Vol 2, 192-196, Copyright © 1988 by European Association for Cardio-thoracic Surgery
Therapeutic consequences of oesophageal function studies in patients with benign oesophageal disease
E Jakobsen, S Kruse-Andersen, L Wallin, T Madsen and K Andersen
Department of Thoracic and Cardiovascular Surgery, Odense University Hospital, Denmark.
Evaluation of oesophageal function was performed in 91 patients referred to
a specialized department of cardiothoracic surgery for surgical treatment
of benign oesophageal disease. Standard manometry was used in addition to
radiology and endoscopy, and in some patients, an acid perfusion test, an
acid clearing test, and a prolonged monitoring of pH in the distal
oesophagus were additionally performed. The aim of this study was to
evaluate whether assessment of oesophageal function is needed in such a
patient group, and whether the results of these investigations were taken
into account when making the final decision for therapy. Eleven percent of
the patients referred with a diagnosis of hiatal hernia or reflux had
achalasia or oesophageal spasm. Nine percent of the patients referred for
motility disorders had reflux-related disease. The referral diagnosis was
changed to a diagnosis with a different therapeutic approach in 16% of the
patients. In 33%, a diagnosis of disordered oesophageal function was
considered either at referral or during the routine assessment for
oesophageal disease. Eighty-one percent of the patients with achalasia were
treated in accordance with the manometric results. In all cases where an
anatomical diagnosis was replaced by a diagnosis of disordered function,
the treatment was in accordance with the findings of the motility studies.
None of the patients with oesophageal spasm were suspected of having this
disease. It is concluded, that not only anatomical features, but also
functional considerations have to be taken into account when selecting
treatment for benign oesophageal disease. Treatment failure and unnecessary
surgical intervention can thus be avoided.
