Primary Motility  Disorders of the  Esophagus
 The Esophageal
 Esophagogastric  Junction

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Volume: Barrett's Esophagus
Chapter: Diagnosis

What are the lower esophageal sphincter and esophageal body manometric characteristics observed in Barrett's patients?

J.A. Castell (Philadelphia)

Barrett's esophagus is generally recognized as the most severe complication of chronic gastroesophageal reflux disease (GERD). Therefore, it can be anticipated that these patients are likely to show the worst overall defects, including abnormalities of esophageal motility. Many studies over the years have documented that patients with Barrett's esophagus have the greatest amount of acid reflux and also associated reflux of bile. Accompanying motility defects include a greater percentage of abnormal motility, principally ineffective esophageal motility characterized by low amplitude and non-progressive waves, and also a higher percentage of hypotensive lower esophageal sphincter [1]. Thus, Barrett's esophagus represents end stage esophageal damage in the patient with chronic GERD and presents little hope that these motility defects will improve.

The above statement raises the question of which came first, the chronic reflux or the motility abnormality. In the animal laboratory, it is possible to demonstrate dramatic decreases in esophageal motility in response to acid infusion [2]. These experiments are a form of acute injury to the esophagus, with recovery from the abnormal motility as the mucosal defect heals. In the human condition, such a situation has not been described. There is no convincing evidence that the abnormal motility seen in patients with severe chronic GERD is likely to recover after appropriate therapy which heals the esophagitis. This statement applies to both the best medical and surgical therapies. Thus, the motility defect seen in the patient with Barrett's esophagus is a chronic injury. It is my belief that this occurs secondary to the years of chronic reflux and severe acid exposure to the distal esophagus in these patients.


1. Ter RB, Castell DO. Gastroesophageal reflux disease in patients with columnar-lined esophagus. Gastroenterol Clin North Am 1997;26(3):549-563.

2. Eastwood GL, Castell DO, Higgs RH. Experimental esophagitis in cats impairs lower esophageal sphincter pressure. Gastroenterology 1975;69:146-153.

Publication date: August 2003 OESO©2015