May not many of these forms be associated with undiagnosed esophageal reflux ?
J. Bancewicz, M. Marples, T. O'Hanrahan (Manchester)
The nature of most esophageal motility disorders is poorly understood, and treatment is controversial and often less effective than one would like. By contrast gastroesophageal reflux is a condition for which there is highly effective medical and surgical treatment. It therefore seems prudent to search for reflux in any patient with esophageal symptoms that are proving difficult to diagnose or to treat.
For the last ten years we have therefore pursued a policy of actively excluding gastroesophageal reflux before any esophageal motility disturbance is labelled as « primary » or « idiopathic ». This policy has been followed regardless of the nature of the symptoms and the initial impressions gained from X-rays or motility studies done in the referring hospital. Radiology and endoscopy have an important part in assessing reflux, but our principal tool has been 24-hour esophageal pH recording.
We have reviewed the records of 1132 consecutive studies in our esophageal laboratory: 59.3 p. cent had an esophageal motility disorder and the distribution of the various disorders is shown in the table. The prevalence of gastroesophageal reflux is also shown in table 1. As can be seen, reflux is a common finding in every group with the exception of achalasia. In untreated achalasia, there is often high acid exposure, but this is usually due to fermentation of retained foodstuff with the production of lactic acid [1].
Table 1. Motor disorders and gastroesophageal reflux
|
Motility |
n |
% with reflux |
||
|
Normal |
461 |
50.0 |
||
|
Non-specific motor disorder |
489 |
54.2 |
||
|
Diffuse spasm |
42 |
21.4 |
||
|
Achalasia |
53 |
- |
||
|
Nutcracker |
64 |
35.9 |
||
|
Scleroderma |
6 |
33.3 |
||
|
Other (eg. neurological) |
17 |
0.0 |
||
|
Total |
1 132 |
44.0 |
||
It is self evident from these data that esophageal motility disorders are commonly associated with reflux. However, this sort of information does not allow one to say whether the association is causal or coincidental. Careful study of the effect of treating reflux on the motility disorders is therefore required.
Reference