Esophageal Motility Dysfunction Research Articles

Vasoactive Intestinal Peptide Receptor, CRTH2, Antagonist Treatment Improves Eosinophil and Mast Cell-Mediated Esophageal Remodeling and Motility Dysfunction in Eosinophilic Esophagitis.

Ultrasonography has shown that eosinophils accumulate in each segment of the esophageal mucosa in human EoE, ultimately promoting esophageal motility dysfunction; however, no mechanistic evidence explains how or why this accumulation occurs. Quantitative PCR, ELISA, flow cytometry, immunostaining, and immunofluorescence analyses were performed using antibodies specific to the related antigens and receptors. In deep esophageal biopsies of EoE patients, eosinophils and mast cells accumulate adjacent to nerve cell-derived VIP in each esophageal segment. qRT-PCR analysis revealed five- to sixfold increases in expression levels of VIP, CRTH2, and VAPC2 receptors and proteins in human blood- and tissue-accumulated eosinophils and mast cells. We also observed a significant correlation between mRNA CRTH2 levels and eosinophil- and nerve cell-derived VIPs in human EoE (p < 0.05). We provide evidence that eosinophil and mast cell deficiency following CRTH2 antagonist treatment improves motility dysfunction in a chronic DOX-inducible CC10-IL-13 murine model of experimental EoE. CRTH2 antagonist treatment is a novel therapeutic strategy for inflammatory cell-induced esophageal motility dysfunction in IL-13-induced chronic experimental EoE.

Incidence of opioid-induced esophageal dysfunction.

Retrospective studies have suggested that long-term use of opioids can cause esophageal motility dysfunction. A recent clinical entity known as opioid-induced esophageal dysfunction (OIED) has been postulated. There is no data from prospective studies assessing the incidence of opioid-induced effects on the esophagus. Evaluate the incidence of OIED during chronic opioid therapy. From February 2017 to August 2018, all patients seen in the Pain Unit of the hospital, who started opioid treatment for chronic non-neoplastic pain and who did not present esophageal symptoms previously, were included. The presence of esophageal symptoms was assessed using the Eckardt score after 3 months and 1 year since the start of the study. In February 2021, the clinical records of all included patients were reviewed to assess whether esophageal symptoms were present and whether opioid therapy was continued. In patients presenting with esophageal symptoms, an endoscopy was performed and, if normal, a high-resolution esophageal manometry was performed. For a confidence level of 95%, a 4% margin of error and an estimated prevalence of 4%, a sample size of 92 patients was calculated. 100 patients were included and followed while taking opioids, for a median of 31 months with a range between 4 and 48 months. Three women presented with dysphagia during the first 3 months of treatment, being diagnosed with esophagogastric junction outflow obstruction; type II and type III achalasia. The cumulative incidence of OIED was 3%; 95%-CI: 0-6%. Chronic opioid therapy in patients with chronic non-neoplastic pain is associated with symptomatic esophageal dysfunction.

Esophageal motility disorders in symptomatic patients and its relation to age

BackgroundAlthough swallowing disorders can impact individuals of any age, some are unique to the elderly, and others are frequent. Some disorders, such as achalasia, are diagnosed by esophageal manometry studies, which assess lower esophageal sphincter (LES) pressure and relaxation, peristalsis in the esophageal body, and contraction wave characteristics. This research aimed to evaluate esophageal motility dysfunction in symptomatic patients and its relation to age.MethodsConventional esophageal manometry was performed on 385 symptomatic patients who were divided into two groups; Group A (age < 65 years old) and Group B (age ≥ 65 years). The geriatric assessment for Group B included cognitive, functional, and clinical frailty scales (CFS). Additionally, a nutritional assessment was done for all patients.ResultsAbout one-third of the patients (33%) had achalasia, in which manometric results were significantly higher in Group B (43.4%) than in Group A (28.7%) (P = 0.016).The resting lower esophageal sphincter (LES) pressure, as determined by manometry examination, was significantly lower in Group A than in Group B. In contrast, complete LES relaxation percentage and normal esophageal body peristalsis were significantly higher in Group A than in Group B. Patients who exhibited evidence of achalasia in the manometric study had a significantly increased risk of established malnutrition and functional impairment.ConclusionsAchalasia is a prevalent cause of dysphagia in elderly patients, placing them at risk of malnutrition and functional impairment. Thus, a multidisciplinary approach is vital when providing care for this population.

A concise review of opioid-induced esophageal dysfunction: is this a new clinical entity?

Opioids have become the most widely prescribed analgesics in Western countries. Opioid-induced bowel dysfunction is a widely known adverse effect, with constipation the most common manifestation. Most of the opioid-related effects occur in the stomach, small intestine, and colon and have been widely studied. However, the effects related to esophageal motility are less known. Recently published retrospective studies have suggested that long-term use of opioids can cause esophageal motility dysfunction, reflecting symptoms similar to motility disorders, such as achalasia and functional esophagogastric junction outflow obstruction. The most common manometric findings, as reported in the literature, for patients with opioid-induced dysphagia undergoing long-term therapy with these drugs are impaired lower esophageal sphincter relaxation, high amplitude/velocity, and simultaneous esophageal waves, higher integrated relaxation pressure, lower distal latency, and the esophageal contractility can be normal, hypercontractile, or premature. Based on these studies, a new clinical entity known as opioid-induced esophageal dysfunction has been postulated. For these patients, the diagnostic method of choice is high-resolution manometry, although other causes should be ruled out through endoscopy or Computed Tomography (CT). The best therapeutic option for these patients is withdrawal of the opioid; however, this is not always possible, and other options need to be investigated, such as pneumatic dilation and botulinum toxin injection, considering the risks versus the benefits.

Relationship between the severity of reflux esophagitis and the esophageal motility features on high resolution manometry

Objective: To analyze esophageal motility dysfunction in gastroesophageal reflux disease (GERD) with different severity of esophagitis, and the relationship between the esophageal motility dysfunction and the severity of esophagitis. Methods: GERD patients simultaneously undergone endoscopy and high-resolution manometry were divided into four groups: Non-esophagitis (Non-erosive gastroesophageal reflux disease, NERD) group, mild esophagitis group, moderate esophagitis group and severe esophagitis group. The gender and age were matched for each group, and every group consisted of 80 cases. Nonparametric test was used to analyze the differences in HRM parameters, such as upper esophageal sphincter (UES) pressure, lower esophageal sphincter (LES) pressure, LES length, LES-CD (crural diaphragm) separation distance, and the percentage of failed peristalsis of the four groups, and the differences between each two of the groups were also analyzed. Results: Nonparametric test showed that the LES pressure and length decreased with the severity of esophagitis, and there were statistical differences (P<0.001, P=0.030). The failed peristalsis percentage increased with the severity of esophagitis and the difference was statistically significant (P<0.001). The LES-CD separation distance was increased with the severity of esophagitis and had statistically significance (P<0.001). When comparing the differences between each two of the groups, there were significant differences (P<0.001, P=0.012, P<0.001, P<0.001) between NERD group and severe esophagitis group in the HRM parameters of the lower esophageal sphincter pressure, the LES length, the LES-CD separation distance, and the percentage of ineffective swallowing in the NERD and severe esophagitis group. The detection rate of HH was significantly increased from NERD to severe esophagitis, the detection rate of HH was 6.3% to 82.5% in gastoracopy and 16.3% to 45.0% in HRM, and the diagnostic consistency was fair (Kappa Value: 0.31). Conclusions: Hypo-dynamic state of esophageal and HH are the main motility characteristics of erosive gastroesophageal reflux disease, Esophageal motility abnormalities increase in parallel with the severity of GERD from NERD to severe esophagitis, these motility disorders may also play important roles in causing esophagitis.

Evaluation of Esophageal Functions by Manometry in Iron Deficiency Anemia Patients.

BackgroundThe aim of this study was to investigate whether any esophageal motor dysfunction exists in patients with iron deficiency anemia (IDA).MethodsThe study included 39 patients (34 women, mean age: 44.17 ± 14.21 years) who met WHO diagnostic criteria for IDA. An additional 30 functional dyspepsia patients were also included as a control group. Esophageal motility testing was performed; esophagus contraction amplitude, peak velocity, contraction time, lower esophageal sphincter (LES) resting pressure, LES relaxation, and LES relaxation duration were assessed.ResultsA majority (76.4%) of patients had at least one IDA symptom, such as reflux, chest pain, or dysphagia. Manometric findings in IDA patients vs. controls were as follows: mean LES resting pressure (mm Hg): 25.41 ± 11.67 vs. 19.96 ± 6.58 (P = 0.025); mean esophageal contraction amplitude (mm Hg): 61.61 ± 24.21 vs. 63.23 ± 18.86 (P = 0.764); mean LES relaxation duration (s, x ± SD): 5.33 ± 1.61 vs. 8.75 ± 1.86 (P = 0.000); mean LES relaxation (%): 93.30 ± 9.88 vs. 95.53 ± 5.81 (P = 0.278); mean peak velocity (cm/s): 12.67 ± 37.95 vs. 3.50 ± 1.63 (P = 0.191). Esophageal dysmotility was found in 11 (28.2%) IDA patients. Non-specific esophageal motor disorder was found in three patients, hypomotility of the esophagus was found in three patients, achalasia was found in two patients, hypertensive LES was found in two patients, and hypotensive LES was found in one patient.ConclusionLES resting pressure was higher and LES relaxation duration was shorter in patients with IDA. Esophageal dysmotility was present in 28.2% of the patients with IDA A little more than half of patients had dysphagia symptoms. IDA may contribute to esophageal motility dysfunction and esophageal symptoms.

Effects of transcutaneous electro acupuncture stimulation on esophageal motility of forty-five patients with refractory gastroesophageal reflux disease

Objective To investigate the effects of transcutaneous electro acupuncture stimulation (TEA) on esophageal motility of patients with refractory gastroesophageal reflux disease (RGERD) by high resolution manometry (HRM), and to provide a new treatment option for RGERD. Methods From February 2014 to June 2015, a total of 45 patients with RGERD were enrolled. TEA instrument was used for electro acupuncture stimulation at the points of Zusanli and Neiguan. HRM was carried out before and after treatment. The changes of HRM parameters such as lower esophageal sphincter pressure (LESP), distal contractile integral (DCI), and amplitude of 3 cm, 7 cm above lower esophageal sphincter (LES), esophageal body velocity and contractile front velocity (CFV) were also compared. The paired-samples t test was performed for statistical analysis. Results According to LESP value, 45 patients were divided into low LESP group (10 patients) and normal LESP group (35 patients). According to parameter of esophageal motility function, patients were divided into esophageal dysmotility group (25 patients) and normal esophageal motility group (20 patients). After TEA treatment, the LESP of lower LESP group was (14.83±4.17) mmHg (1 mmHg=0.133 kPa), which was higher than that before treatment ((9.54±2.42) mmHg), and the difference was statistically significant (t=4.92, P=0.001). LESP of esophageal dysmotility group was (19.04±5.91) mmHg, which was higher than that before treatment ((16.20±6.09) mmHg), and the difference was statistically significant (t=4.92, P=0.001). There was no statistically significant difference in LESP of normal LESP group and normal esophageal motility group before and after treatment (both P>0.05). After treatment, DCI of esophageal dysmotility group was (530.76±215.53) mmHg·cm·s, which was higher than that before treatment ((363.92±279.17) mmHg·cm·s), and the difference was statistically significant (t=2.86, P 0.05). There was no statistically significant difference in all of the esophageal motility parameters in normal esophageal motility group before and after treatment (all P>0.05). Conclusion TEA can increase LESP and DCI in RGERD patients with esophageal motility dysfunction, improve contraction of entire esophagus and raise esophageal clearance capacity. Key words: Refractory gastroesophageal reflux disease; Transcutaneous electro acupuncture stimulation; High resolution manometry, esophageal; Esophageal motility

Esophageal dysmotility is present before surgery in isolated tracheoesophageal fistula.

After surgical correction of esophageal atresia with or without tracheoesophageal fistula, esophageal body motility dysfunction has been reported in nearly all patients. Using high-resolution esophageal manometry before surgical repair in 2 children with isolated tracheoesophageal fistula, we sought to determine whether dysmotility was present before any surgical insult to test the hypothesis that dysmotility associated with esophageal atresia with or without tracheoesophageal fistula is related to intrinsic primary factors linked to abnormal development of the esophagus. Both had an abnormal esophageal motility: one exhibited hypomotility with distal contraction, whereas the other showed a complete aperistalsis pattern. This suggests that esophageal dysmotility is congenital in nature rather than secondary to surgery.

Pathophysiology and treatment of patients with globus sensation--from the viewpoint of esophageal motility dysfunction.

"Globus sensation" is often described as the sensation of a lump in the throat associated with dry swallowing or the need for dry swallowing, which disappears completely during eating or drinking and for which no organic cause can be established. Due to the uncertain etiology of "globus sensation", it remains difficult to establish standard treatment strategies for affected patients. Lately most attention has been focused on gastroesophageal reflux disease and several reports have indicated that there is a close relationship between esophageal acid reflux and globus sensation. Nowadays, empirical therapy with a high dose of a proton pump inhibitor (PPI) is considered to be indicated for patients with globus sensation, after excluding organic diseases such as pharyngeal cancer, Zenker's diverticulum, or thyroid enlargement. If patients are nonresponsive to PPI therapy, evaluation of esophageal motility should be done. In our recent study, 47.9% had abnormal esophageal motility, with the most common esophageal motility abnormality being an ineffective esophageal motility in PPI-resistant patients with globus sensation. This suggests that prokinetics alone or adding prokinetics to PPI should be the treatment to be considered, although few studies have investigated the efficacy of prokinetics in the treatment of patients with globus sensation. If patients without any esophageal motility dysfunctions are nonresponsive to PPI therapy, either cognitive-behavioral therapy, anti-depressants, or gabapentin could be helpful, although further well-designed, randomized controlled large-scale studies will be necessary to determine the effectiveness of each treatment strategy on patients with globus sensation.

Association between the length of peristaltic break of esophageal body and the severity of the symptoms in patients with non-erosive reflux disease and negative pH monitoring

Objective To explore the correlation between the length of peristaltic break (LPB) and the severity of the symptoms in patients with non-erosive reflux disease (NERD) and negative pH monitoring.Methods A total of 35 patients with NERD and negative pH monitoring were enrolled,and at same time 10 healthy individuals were selected as controls.The LPB of esophageal body of both groups was measured by high resolution manometry (HRM).Meanwhile,the symptom of NERD patients with negative pH monitoring was scored.The LPB of esophageal body between the two groups was compared by t test.The correlation between the LPB and the severity of the symptoms in NERD patients with negative pH monitoring was analyzed by Pearson correlation analysis.Results The average LPB of esophageal body of NERD patients with negative pH monitoring was (3.3±0.9)cm,which was longer than that of healthy controls ((1.2 ± 0.4) cm),and the difference was statistically significant (t=9.17,P＜0.01).The symptom score of NERD patients with negative pH monitoring was 21.6± 7.8.There was a positive correlation between the LPB and NERD symptom score (r=0.894,P＜ 0.01).Conclusion The LPB of esophageal body is a kind of expression of esophageal motility dysfunction,which is correlated with the symptom of NERD. Key words: Hydrogen-ion concentration; Gastroesophageal reflux; Manometry; Peristalsis

Diabetes mellitus and its association with esophageal disorders besides motility dysfunction

1The authors have shown a clear and signifi cant relationship between diabetes and the gastroesophageal refl ux as well as esophageal motility dysfunction. Interestingly, while esophageal research in diabetics focuses mostly on motility dysfunction, it is often forgotten that diabetic patients are at a higher risk for a number of other esophageal disorders besides motility dysfunction. For instance, nearly 28% of patients who develop “black esophagus” have underlying diabetes mellitus. 2 The increased incidence of gastroesophageal refl ux as well candidal infections in diabetics are some of the aggravating factors that contribute to this increased incidence in diabetic patients. Besides this, a number of structural changes occur in the esophagus in diabetic patients. For instance, increased mucosal as well as submucosal thickness of the esophageal wall occurs commonly and contributes further to the altered esophageal motility. 3 Similarly, diabetic patients with secondary autonomic neuropathy have an increased incidence of esophagitis. 4 Obesity is another major altered parameter noticed in diabetic patients. This factor is signifi cant because obese individuals with a body mass index of more than 30 are almost 4 times as likely as nonobese individuals to develop Barrett’s esophagitis. 5 In fact, Kuriki et al., in a recent Japanese study, have demonstrated that males with diabetes are almost 1.7 times more likely to develop esophageal carcinoma in comparison to nondiabetics. 6

Effect of esomeprazole and mosapride on the esophageal motility dysfunction in elderly patients with hypotensive LES: an analysis of 29 cases

Effect of esomeprazole and mosapride on the esophageal motility dysfunction in elderly patients with hypotensive LES: an analysis of 29 cases

Corrosive Ingestions

Corrosive Ingestions

Abnormal acid reflux in asthmatic patients in a region with low GERD prevalence

A high prevalence of gastroesophageal reflux disease (GERD) in asthmatic patients has been reported from North America and Europe. However, only a few data from Asia are available. This study evaluated the incidence of abnormal gastroesophageal reflux (GER) in asthmatic patients in Taiwan. Fifty-six consecutive ambulatory patients with clinically stable asthma (41 men and 15 women; age, 57.7 +/- 12.4 years; range, 24 to 74 years) were evaluated prospectively. All patients underwent esophagogastroduodenoscopy, esophageal manometry, and 24-h esophageal pH monitoring. Twenty-nine patients (51.8%) had abnormal GER, as defined by 24-h esophageal pH monitoring. There were 42 patients without endoscopic evidence of esophagitis, 10 patients with Los Angeles (LA) grade A esophagitis, and 4 patients with LA grade B esophagitis. The esophageal motility function studies revealed 21 patients with normal esophageal motility, 23 patients with ineffective esophageal motility (IEM), and 12 patients with nonspecific esophageal motility disorders other than IEM. Although the lower esophageal sphincter (LES) basal pressure was higher in the patients without GER, the difference was not statistically significant. Abnormal GER seems to be a clinically significant problem in asthmatic patients in Taiwan. The most common esophageal motility dysfunction is IEM. However, the status of Helicobacter pylori infection plays no role in abnormal GER.

Effect of Helicobacter pylori infection on intragastric acidity in patients with reflux esophagitis

The effect of Helicobacter pylori infection on intragastric acidity in patients with reflux esophagitis was investigated. Esophageal motility and 24-h intragastric acidity were assessed in endoscopy-proven reflux esophagitis patients with ( n = 50) and without ( n = 50) H. pylori infection. Most of the patients had a mild degree of esophagitis. There was no difference in the age, sex, or body mass index (BMI) between patients with and without H. pylori infection. The 24-h intragastric pH monitoring showed less acidity in patients with H. pylori infection than in those without H. pylori infection (median pH, 1.6 +/- 0.3 vs 1.4 +/- 0.1, with vs without H. pylori infection; P < 0.01). No difference in the patterns of esophageal motility dysfunction was noted between these two groups of patients. Patients with reflux esophagitis and H. pylori infection had less intragastric acidity than those without H. pylori infection. However, the extent of acid suppression was insufficient to protect the esophagus from acid injury. In addition, the degree of esophageal motility dysfunction was similar in both groups. Therefore, H. pylori infection may play no role in the pathogenesis of reflux esophagitis.

Effects of nitric oxide synthase inhibitor to esophagus in a feline esophagitis model.

The present study explores the effects of nitric oxide synthase inhibitor on esophageal motility in a feline model with esophagitis. Perfusion of the esophagus with acid produced inflammatory changes of esophageal mucosa. The esophageal motility was measured before and after the perfusion. One group of cats was given nitric oxide inhibitor orally at the same time as the perfusion of acid. The control group was given water instead. Esophagitis impairs the motility of the esophagus. However, the esophageal motility of the cats that were given nitric oxide synthase inhibitor decreased less than that of the control group. The results suggested that during esophagitis there is an alteration of the nitric oxide synthase/nitric oxide pathway in the esophagus, which may be one of the important mechanisms of esophageal motility dysfunction.

Autonomic Nerve Dysfunction is Closely Associated with the Abnormalities of Esophageal Motility in Reflux Esophagitis

Background: While reflux esophagitis (RE) is often associated with esophageal motility dysfunction, the causes of this abnormal motility are not well understood. The aim of our study was to assess the relationship between esophageal motility and autonomic nerve dysfunction by comparing 14 healthy control subjects (11 M, 3 F; mean age, 56.4 years) with 26 patients with RE (19 M, 7 F; mean age, 60.4 years). Methods: According to results of esophageal manometry, subjects with RE were assigned to group I (RE with esophageal motility dysfunction, n = 12) or group N (RE without motility dysfunction, n = 14). Autonomic neuropathy was assessed by measuring the heart rate coefficient of variation at rest (CVR-R), the Valsalva ratio for the R-R interval, the systolic blood pressure response to mental calculation, and the antral contractile response to modified sham feeding (MSF). Results: CVR-R at rest was lower in group I (2.08 ± 0.18) than in group N (3.80 ± 0.44; P < 0.05). The frequency of antral contractile response to MSF per 3-min interval over 15 min was significantly lower in group I than in either group N or controls. The 15-min integrated antral contractile response, taken as the area under the contraction time curve, was much lower in group I (13.2 ± 6.2) than in controls (55.6 ± 9.2; P < 0.01). Conclusions: We conclude that esophageal motor dysfunction in some patients with RE may result from autonomic dysfunction.

Sildenafil citrate: A therapeutic update

Background: Since its approval by the US Food and Drug Administration in March 1998, sildenafil citrate has been used by millions of men for the treatment of erectile dysfunction. Recent studies and consensus reports have expanded our understanding of its efficacy, safety, contraindications, and drug interactions. Objective: This paper reviews recent studies of the efficacy of sildenafil, its adverse effects and drug interactions, and socioeconomic factors involved in its use, with a focus on specific patient populations (prostate cancer, diabetes mellitus, ischemic heart disease, spinal cord injuries, neurologic disorders). Methods: Clinical studies, case reports, and commentaries and editorials concerning sildenafil published in the international literature between January 1999 and August 2000 were identified through searches of MEDLINE®, PREMEDLINE®, and International Pharmaceutical Abstracts®, using the terms sildenafil, Viagra, and erectile dysfunction. Results: Sildenafil has demonstrated effectiveness in men with erectile dysfunction associated with prostatectomy, radiation therapy, diabetes mellitus, certain neurologic disorders, and drug therapy (eg, selective serotonin reuptake inhibitors [SSRIs]). It has not been as effective in women with sexual dysfunction, with the exception of SSRI-associated sexual dysfunction. Some disorders unrelated to sexual dysfunction (eg, esophageal motility dysfunction) may also respond to sildenafil. In the general population, sildenafil is considered to have an acceptable tolerability profile; however, patients with moderate to severe cardiovascular disease or those taking nitrate therapy are at increased risk for potentially serious cardiovascular adverse effects with sildenafil therapy. In addition, patients taking drugs that inhibit the cytochrome P450 3A4 isozyme, which metabolizes sildenafil, may experience increased drug concentrations and possible toxicity from normal doses of sildenafil. Conclusions: Sildenafil is an effective first-line therapy for erectile dysfunction in men. The decision to prescribe this agent should include such considerations as the cost-risk-benefit balance, patient access, drug distribution pathways, and prescription drug coverage.

Esophageal motility dysfunction in cats: a study of 44 cases

A retrospective study evaluated cases of feline esophageal dysfunction. Cats identified had contrast esophagrams performed during a six-year period. Of 56 cases undergoing esophagography, 51 had complete records available for review. Forty-four cases were felt to be abnormal and were included in the study. Cases were analyzed for signalment, presenting complaints, and identifiable causes of abnormal esophageal motility. Response to treatment and case outcome were also reviewed. The signalment of the cases varied widely, especially in age. The occurrence of esophageal motility dysfunction was low, comprising only 0.05% of all feline cases seen in a six-year period. Forty-three percent of cases were considered idiopathic, and 57% were congenital or diagnosed with conditions known to cause esophageal motility dysfunction. The causative disease states included myasthenia gravis, mediastinal masses, vascular ring anomalies, dysautonomia, and esophageal stricture. Seventy-eight percent of those treated with medical therapy (i.e., combinations of sucralfate, H2 receptor antagonists, and either metoclopramide or cisapride) showed clinical improvement.

Esophagectomy For Unsuccessful Antireflux Operations

Background: Primary antireflux surgery provides excellent symptom relief in most patients. Unfortunately, the results of redo surgery are less predictable. In these patients, esophageal injury from long-standing reflux of gastric contents and operative trauma from previous failed antireflux procedures results in progressive deterioration in esophageal propulsion, poor clearance of reflux episodes, mucosal damage, and, in some cases, stricture formation. For the past 16 years, we have selectively used esophageal resection and replacement instead of another reoperation in these challenging patients. Methods: Seventeen patients with end-stage esophageal body dysfunction and one or more previously unsuccessful antireflux procedures underwent esophagectomy and reconstruction by colon interposition in 15 patients and jejunum interposition in 2 patients. The indications for esophagectomy rather than a redo antireflux procedure were a global loss of effective esophageal motility in 13 and a nondilatable stricture in four. Their outcome was compared with that of 32 patients with adequate motility and 18 with a similar global loss of motility who had a redo antireflux procedure. Perioperative complications after esophagectomy were recorded, and long-term outcome was assessed by means of a standardized questionnaire at a median of 7 years after the operation. Results: Patients with profound esophageal body dysfunction who underwent esophageal resection had outcomes similar to those with normal motility who underwent a redo antireflux procedure. Those with profound esophageal motility dysfunction who underwent a redo antireflux procedure had a worse outcome than those who underwent resection. Esophageal resection and replacement was performed without mortality or graft failure. All patients who underwent resection stated that their preoperative symptoms were relieved completely ( n = 6) or improved ( n = 10). Thirteen patients (81%) were able to eat three meals a day, and 12 patients (75%) enjoyed an unrestricted diet. Two thirds of the patients were at or above their ideal body weight, and 88% were fully satisfied with the outcome of the procedure. Conclusion: Patients with end-stage esophageal body dysfunction who have had a previous unsuccessful antireflux procedure can be treated by esophageal resection with a high expectation of success. (J Thorac Cardiovasc Surg 1998;115:296-302)