Normal Lower-Esophageal-Sphincter Function after Surgical Treatment of Gastroesophageal Reflux

Abstract

To evaluate operations for gastroesophageal reflux, we studied eight patients who had the Hill and seven who had the Belsey procedure. Of these 15, 12 had hiatus hernia, 11 free gastroesophageal reflux of barium, and 10 peptic esophagitis. Two months to four years after operation all but one of these abnormalities disappeared in 14 patients, who were also asymptomatic. Lower-esophageal-sphincter pressure increased from 5.4 ± 0.4 mm HG (mean ± S.E.M.) to 16.5 ± 1.0 after the Hill repair and 12.2 ± 1.3 after the Belsey repair. The difference between the preoperative and postoperative values is highly significant (p < 0.001). Similar improvement marked the response to abdominal compression; peak sphincter response to pentagastrin increased from 17.2 ± 3.7 mm Hg (mean ± S.E.M.) to 35.5 ± 2.9 after the Hill repair and 41.7 ± 7.9 after the Belsey repair. The values after either procedure differed significantly from those obtained before operation (p < 0.001). Thus, the operations result in both clinical improvement and lower-esophageal-sphincter function that appears essentially normal. (N Engl J Med 291:1107–1110, 1974)