Pre- and Postoperative Manometric Study and Histologic Features in Hiatal Hernia and Achalasia of the Esophagus

Sei Shiraha, Jun Noguchi, Masushi Terada, Ryou Izutani, Hiroki Masumoto, Toshinori Sanakouji, Michizou Hayashi, Takeshi Kuyama

Second Department of Surgery, Kinki University School of Medicine

Motility function of patients with hiatal hernia and achalasia as a common motor disorder at the esophagogastric junction was studied by perfusion manometry and the results before and after surgery were compared. Fifteen (46.9%) of 32 patients with hiatal hernia had an intragastric pressure≥10 mmHg and 25 (78.1%) had impaired peristalsis in the distal esophagus. This study shows that the coexistence of high gastric pressure and peristaltic disturbance has the most serious affect on reflux esophagitis. Surgical repair had a good effect on the pressure and length of the lower esopageal pressure (LES), but failed to improve the complete peak contractile pressure and peristaltic velocity. In patients with stenotic esohagitis, degeneration of the myenteric plexus was demonstrated along with remarked fibrosis. When fundoplication was used in the management of peptic stricture, difficulty in swallowing could not be reversed completely, because of persistence of peristaltic failure. Postoperative manometric study in patients with achalasia demonstrated an improvement in LES function. Relaxation of LES reappeared in 76.9% of the 13 patients, but normal peristalsis was not restored. Histologic abnormality of this disease was seen in nerve fibers or axons without disintegration of ganglion cells of Aurebach's plexus. This observation suggests that there may be a variety of pathologic changes according to advance in the stages of achalasia.

Key words
hiatal hernia, achalasia, lower esophageal sphincter pressure

Reprint requests
Sei Shiraha Second Department of Surgery, Kinki University, School of Medicine
337-2 Ohnohigashi, Osaka-sayama, 589 JAPAN

Accepted
June 13, 1990

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