A Follow-Up Study with pH and Pressure Measurements in Patients Treated for Cardiospasm by Heller's Operation

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Abstract
A material of 52 patients operated upon for cardiospasm with a Heller myotomy is presented. The patients were re-examined in average 9 years after operation. Three patients were operated upon for a recur-rency. Sixty-five per cent had no symptoms at all. Of the remaining patients, 50% had mild and 50% distinct symptoms of stenosis. Fifteen per cent had symptoms of gastro-oesophageal reflux. Thirty-four patients were radio-logically re-examined. Eight of these patients had symptoms of regurgitation, which could only be confirmed by X-ray in 1 case. Twenty-nine of the 34 patients were investigated with simultaneous measurements of pH and pressure in the oesophagus and stomach. Five of these patients had symptoms of oesophagitis, but this could only be verified by the pH measurement in 1 patient. The pressure measurements showed great variations in the stomach-sphincter-gradient without any proved relation to the occurrence of reflux. The investigation supports the theory that more factors beyond the internal sphincter are of importance in keeping the cardia competent. However, it cannot support the theory that the distal fibres of the sphincter should be kept intact at operation in order to prevent the risk of refluxoesophagitis. It is stressed that a short incision will not solve the problem, as this procedure increases the tendency to recurrencies and will not prevent regurgitation (Malm, 1956).