Lower oesophageal sphincter pressure changes after treatment of bleeding varices by devascularization and by sclerotherapy

ABSTRACT

This prospective controlled study included 3 groups of 20 patients each. The first group [G.A] were apparently healthy volunteers. The second and third groups [G.B and G.C] were patients with bleeding esophageal varices treated by elective splenectomy-devascularization operation and by elective, chronic, endoscopic sclerotherapy, respectively. Lower esophageal sphincter [LES] pressure and esophageal motility pattern were performed to the control group and to the two treatment groups before and 2 months after therapy. The surgery and the repeated ethanolamine oleate injections resulted in minimal changes in the esophageal manometric tracing. The LES resting and closing pressures were not affected. The mean relaxation time in both groups did not change and was comparable to that of the control group. In [G. B], incomplete relaxation was noticed in 3 patients postoperatively compared to one preoperatively. Prolonged relaxation occurred in 3 patients compared to none and incoordination occurred in 7 patients compared to 2. These changes, however, were statistically insignificant. In [G. C], 4 patients showed incomplete relaxation compared to none in the presclerotherapy assessment. 5 patients recorded incoordinated LES response compared to one. These abnormalities were also of no statistical significance. In [G. C], also sclerotherapy resulted in increased frequency of tertiary, secondary and spontaneous non-propulsive peristalsis in most patients [90%]. However, these abnormal contractions did not take a special pattern. They were not associated with dysphagia, and the upper endoscopies were free. Nevertheless, further studies by pH monitoring, esophageal radionucleotide scan and neuro-histopathology are recommended. As a side issue in this study, the LES resting and contraction pressures in esophageal varices groups were significantly lower than the control group