A CASE OF GASTRO-ESOPHAGEAL REFLUX WITH ESOPHAGEAL SHORTENING AND STRICUTURE TREATED BY COLLIS-NISSEN OPERATION

Abstract

A case of gastro-esophageal reflux with esophageal shortening and severe stricture treated successfully by a funciton-preserving operation is reported with reference to the results of esophago-cardiac function tests.
A 51-year-old male was admitted to our hospital with the complaint of dysphagia and heartburn. Esophageal manometry revealed normal lower esophageal sphincter pressure of 14.9 mmHg, but overnight pH monitoring of the esophagus detected 17 episodes of reflux less than pH 4, which amounted to 9.0% of the monitoring time. Since the esophageal bougie for stricture gave only short periods of symptomatic remission, transabdominal Collis gastroplasty and Nissen fundplication was performed after proximal gastric vagotomy for a concomitant peptic ulcer. As a result, the time of reflux was reduced to 1.1%, with marked improvement of the symptoms, despite the decrease in lower esophageal sphincter pressure to 4.1 mmHg. Esophageal stricture requiring a bougie did not recur for as long as 14 months postoperatively.
The esophageal peptic stricutre, which was unresponsive to conservative treatment, was successfully treated by preventing gstro-esophageal reflux without the risk of esophagectomy. The endoscopic ultrasonography was useful for determining the range of cicatrical formation around the esophageal stricture.