Ultrasonographic study of antral motility in patients with Barrett's oesophagus and erosive oesophagitis

Abstract

Background: Antral contractility and antroduodenal motility are major physiologic determinants of gastric emptying (GE). Delayed GE has been demonstrated in patients with reflux disease. In our previous study, using ultrasonography, we have investigated the role of the proximal stomach in the GE of patients with erosive oesophagitis (EO) or with Barrett's oesophagus (BO). The aim of the present study was the assessment of the antral contractility and its role in GE in these two subsets of patients with reflux disease. Patients and methods: Twenty-one patients BO, 17 patients with moderate EO (10 LA-A; 7 LA-B), and 19 control persons (CP) without history of reflux symptoms or dyspepsia were enrolled into the study. After an overnight fast the subjects ingested 500ml of a low calorie content semisolid test meal. The GE was characterized by the reduction of the residual gastric content calculated from the change of cross-sectional areas determined at predefined time points over a period of 240min after ingestion of the test meal. The frequency of antral contractions was counted for 3min at each time point. The amplitude of contractions was calculated from the maximal reduction of the antral area for each contraction. The motility index (MI) was expressed as the multiplication of the mean amplitude and frequency of the contractions. Results: GE was significantly slower in patients with BO and EO than in CP. In patients with BO a significant decrease of the MI was observed in the first 90 minutes of the study, whereas significant reduction of MI occurred only in the first 45 minutes in patients with EO. A negative correlation was observed between the GE and MI in the first 45min of the study in both groups of patients with reflux disease. Conclusions: Impaired antral motility and delayed GE are demonstrated in patients with BO and EO. Antral dysmotility was more pronounced in patients with BO. A possible role of increased biliary reflux in patients with BO warrants further investigation.