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Does the persistence of an LES high-pressure zone prevent reflux after a Heller myotomy ?
W.J. Dodds (Milwaukee) J.E. Richter (Birmingham)
In achalasia patients, the incidence of reflux esophagitis is about 3 p. cent of patients whereas reflux esophagitis is reported to occur in as high as 25-50 p. cent of patients who undergo a Heller cardiomyotomy [1]. However, the question of whether the persistence of an LES high-pressure zone prevents reflux post myotomy in achalasia patients is difficult to answer definitively. Negligible data is available about
measurements of LES pressure before and after myotomy although some data is available from patients undergoing forceful sphincteric dilatation.
In a 1972 study using infused-catheter manometry, Heitman and Wienbeck [2] reported that resting LES pressure decreased from 19 ± 7 SD mmHg to 7 ± 2 mmHg in 10 achalasia patients who underwent a pneumatic dilatation. The authors concluded that the low post-dilatation LES values were sufficient to prevent reflux. Similarly, Ellis et al. concluded that after myotomy that «the maintenance of a short segment of high pressure in the region of the sphincter accounts for a very low incidence of reflux » in their series of patients [1].
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