Does aperistalsis, in certain cases, lead to abandon a Nissen type procedure on behalf of a direct resection?
Esophagitis in patients with aperistaIsis, most commonly scleroderma or achalasia following myotomy, is a perplexing problem. These patients have defects in both major components of the body’s defense mechanism against gastroesophageal reflux, i.e. the lower esophageal sphincter is unable to prevent gastroesophageal reflux, and aperistaIsis renders the esophagus incapable of clearing gastroesophageal reflux in an efficient manner. This produces a particularly severe form of reflux that often results in transmural esophageal strictures. Fundoplication prevents reflux by augmenting lower esophageal sphincter pressure; however, this increase in sphincter pressure works both ways; reflux is prevented, but there is also an increase in resistance to the antegrade passage of food. This is no problem in patients with normal peristaIsis, since this slight increase in resistance may be easily overcome. These unfortunate patients with aperistaIsis, however, have only the hydrostatic pressure of the column of fluid in the esophagus to promote emptying.