Segmental and total oesophageal transit time in patients with corrosive-induced oesophageal stricture.

INTRODUCTION

The mainstay of treatment of corrosive oesophageal strictures is endoscopic dilatation. However, even after adequate dilatation, some patients may continue to have dysphagia. An associated oesophageal motor dysfunction in such patients may contribute to the persistence of dysphagia.

AIM

To assess oesophageal motor dysfunction in patients with corrosive strictures using segmental and total oesophageal transit time by radionuclide scintigraphy.

METHODS

Thirty-five patients with corrosive-induced oesophageal strictures were evaluated after having achieved a dilatation of 15 mm. All patients underwent barium swallow and upper endoscopy for assessment of stricture(s). Oesophageal motility was assessed by radionuclide scintigraphy using Tc sulfur colloid. Total oesophageal transit time (ETT) and segmental (upper, middle and lower third of oesophagus) ETT were determined.

RESULTS

Thirty-five patients (age 18-53 years) were evaluated. Twenty-eight (80%) patients had a single stricture while seven (20%) had either two or three strictures. Eighteen patients had no dysphagia, 13 patients had grade 1 dysphagia and four patients grade 2 dysphagia. Total ETT was prolonged in 12 patients. Upper, middle and lower third ETT was prolonged in four, seven and six patients, respectively. Length of the stricture correlated with prolongation of ETT as 6.66% patients with length < or = 5 cm, and 53.84% of patients with length >5 cm had prolonged total ETT (P=0.019). Patients with tortuous stricture had more prolongation of ETT as compared to those with straight strictures though it did not reach statistical significance. No significant correlation was observed between number of strictures and prolongation of total ETT. The severity of dysphagia correlated with prolongation of total ETT (P=0.011).

CONCLUSION

Oesophageal transit time as assessed by scintigraphy is prolonged in one-third of patients with corrosive-induced oesophageal strictures despite having achieved adequate dilatation. Prolongation of ETT correlates with length of the stricture and severity of dysphagia correlates with prolongation of total ETT. These observations suggest impairment of oesophageal motility in these patients.