Symptoms and Functional Foregut Abnormalities in Patients with Complications of Gastroesophageal Reflux Disease

  • Sebastian Hoeft
  • Hubert J. Stein
  • Tom R. DeMeester
Conference paper


The factors predisposing to the development of Barrett’s esophagus in patients with gastroesophageal reflux disease are unclear. Assessing symptoms, esophageal acid and alkaline exposure (pH <2, <3, <4, and >7), lower esophageal sphincter resistance, esophageal clearance function, the gastric secretory state, gastric emptying, and duodenogastric reflux, we compared 15 patients with Barrett’s esophagus to 24 patients with esophagitis, and 22 normal subjects. Compared to patients with esophagitis, patients with Barrett’s esophagus had less heartburn and regurgitation, but an increased frequency and duration of reflux episodes, and increased percentage of time at pH <2, <3, <4 and pH >7 on ambulatory 24-hour esophageal pH monitoring. This was associated with decreased lower esophageal sphincter resistance, a decreased contraction amplitude in the distal esophagus, an increased frequency of nonperistaltic contractions and contractions <30 mmHg on 24-h ambulatory esophageal motility monitoring, increased basal and stimulated gastric acid secretion, and a higher prevalence of excessive duodenogastric reflux. These data show that despite having less symptoms, patients with Barrett’s esophagus have a markedly increased esophageal acid and alkaline exposure compared to patients with esophagitis. This appears to be due to persistent reflux of concentrated gastric acid and duodenal contents across a mechanically defective lower esophageal sphincter, in combination with inefficient esophageal clearance function.


Lower Esophageal Sphincter Gastric Acid Secretion Gastroesophageal Reflux Disease Columnar Epithelium Reflux Episode 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Sarr MG, Hamilton FR, Marone GC, Cameron JL (1985) Barrett’s esophagus: Its prevalence and association with symptoms of gastroesophageal reflux. Am J Surg 149: 187–193PubMedCrossRefGoogle Scholar
  2. 2.
    Winters C, Spurling TJ, Chobanian SJ, et al (1987) Barrett’s esophagus: A prevalent, occult complication of gastroesophageal reflux disease. Gastroenterology 92: 118–124PubMedGoogle Scholar
  3. 3.
    DeMeester TR, Stein HJ, Fuchs KH (1991) Diagnostic studies in the evaluation of the esophagus: Physiologic diagnostic studies. In: Shackelford RT, Zuidema GD (eds) Surgery of the alimentary tract, vol 1, 3rd edn. WB Saunders, Philadelphia, pp 94–126Google Scholar
  4. 4.
    Stein HJ, DeMeester TR, Hinder RA (1992) Outpatient physiological testing and surgical management of foregut motor disorders. Curr Probl Surg 29: 415–555CrossRefGoogle Scholar
  5. 5.
    Naef AP, Savary M, Ozello L (1975) Columnar lined lower esophagus: An acquired lesion with malignant predisposition. Report on 140 cases of Barrett’s esophagus with 12 adenocarcinomas. J Thorac Cardiovasc Surg 70: 826–834PubMedGoogle Scholar
  6. 6.
    Iascone C, DeMeester TR, Little AG, Skinner DB (1983) Barrett’s esophagus: Functional assessment, proposed pathogenesis and surgical therapy. Arch Surg 118: 543–549PubMedCrossRefGoogle Scholar
  7. 7.
    Gillen P, Keeling P, Byrne PJ, Hennessy TPJ (1987) Barrett’s oesophagus: pH profile. Br J Surg 74: 774–776PubMedCrossRefGoogle Scholar
  8. 8.
    Mulholland MW, Reid, Levine DS, Rubin CE (1989) Elevated gastric acid secretion in patients with Barrett’s metaplastic epithelium. Dig Dis Sci 34: 1329–1335PubMedCrossRefGoogle Scholar
  9. 9.
    Stein HJ, DeMeester TR, Naspetti R, Jamieson J, Naspetti R, Perry R (1991) The three dimensional lower esophageal sphincter pressure profile in gastroesophageal reflux disease. Ann Surg 214: 374–384PubMedCrossRefGoogle Scholar
  10. 10.
    Kahrilas PJ, Dodds WJ, Hogan WJ (1988) Effect of peristaltic dysfunction on esophageal volume clearance. Gastroenterology 94: 73–80PubMedGoogle Scholar
  11. 11.
    Stein HJ, Feussner H, Barthlen W, DeMeester TR, Siewert JR (1992) Alkalischer gastroösophagealer Reflux—Quantifizierung und klinische Relevanz. Langenbecks Arch Chir For Suppl 87–91Google Scholar
  12. 12.
    Attwood SEA, DeMeester TR, Bremner CB, Barlow AP, Hinder RA (1989) Alkaline gastroesophageal reflux: Implications in the development of complications in Barrett’s columnar-lined lower esophagus. Surgery 106: 764–770Google Scholar
  13. 13.
    Waring JP, Legrand J, Chibichian A, Sanowski RA (1990) Duodenogastric reflux in patients with Barrett’s esophagus. Dig Dis Sci 35: 759–762PubMedCrossRefGoogle Scholar
  14. 14.
    Bremner CG (1989) Barrett’s oesophagus. Br J Surg 76: 995–996PubMedCrossRefGoogle Scholar
  15. 15.
    DeMeester TR, Attwood SEA, Smyrk TC, Therkildsen DH, Hinder RA (1990) Surgical therapy in Barrett’s esophagus. Ann Surg 212: 528–542PubMedCrossRefGoogle Scholar
  16. 16.
    McCallum RW, Polepalle S, Davenport K, Boyd S (1991) Role of antireflux surgery against dysplasia in Barrett’s esophagus. Gastroenterology 100:(A)121Google Scholar

Copyright information

© Springer-Verlag Tokyo 1993

Authors and Affiliations

  • Sebastian Hoeft
  • Hubert J. Stein
  • Tom R. DeMeester
    • 1
  1. 1.Department of SurgeryUniversity of Southern CaliforniaLos AngelesUSA

Personalised recommendations