[The role of esophageal manometry in the management of the patients with gastro-esophageal reflux disease and Barrett's esophagus].

AIM To analyze the correlation between the failure of medical treatment in patients with reflux esophagitis or Barrett esophagus and LES function, manometrically measured. METHODOLOGY This is a prospective study of 24 patients admitted in our clinic for reflux disease symptoms, who were investigated by endoscopy (combined with biopsy), esophageal manometry and 24 h pH monitoring. The including criteria for the patients was abnormal esophageal exposure to acid reflux, each patient having abnormal 24 h pH monitoring (pH < 4 in the esophagus more then 4.4% in 24 h). Each patient received medical treatment with clinic and endoscopic reevaluation after 3 months. RESULTS From the 24 patients that were included: 4 patients having Barrett esophagus, 13 patients with esophagitis (3 patients associated complications such as ulcer or esophageal stenosis) and 7 patients without visible lesions on endoscopy. From the 24 patients, 11 patients presented an incompetent LES, characterized by the following values obtained by manometry: total length < or = 2 cm, abdominal length < or = 1 cm, mean pressure: < 6 mmHg. There were 2 patients from the 4 having Barrett esophagus that presented an incompetent LES, and also the 3 patients having esophagitis associated with complications. All patients were reevaluated clinically and endoscopically after 3 months of medical treatment with PPI 40 mg/day. From the 11 patients with incompetent LES, 5 patients had symptoms or modifications on endoscopy, whereas from 13 patients with a competent LES only one patient presented with symptoms of reflux disease. CONCLUSION The presence of an incompetent LES may be a cause of a poor response to medical treatment and may also be an element for taking into consideration surgical treatment.