The effect of symptoms and nonspecific motility abnormalities on outcomes of surgical therapy for gastroesophageal reflux disease.
The outcome of Nissen fundoplication in patients with a nonspecific motility abnormality compared with the outcome in patients with normal motility is unknown. One hundred consecutive patients who underwent primary Nissen fundoplication were evaluated before and a median of 50 months after operation, with emphasis on the presence of a preoperative motility disorder and its relationship to preoperative and postoperative symptoms. Compared with patients who had normal motility, patients with a nonspecific motility abnormality had a greater prevalence and severity of heartburn and regurgitation before operation. These patients also had a greater esophageal exposure to gastric juice on pH monitoring as a result of poorer esophageal clearance function. The prevalence and severity of preoperative dysphagia was not related to the presence of a motility disorder. A 90% or a 95% actuarial success rate was achieved in the relief of heartburn and regurgitation over a 96-month period in patients with and without a motility abnormality. The overall actuarial success rate was 93%. Dysphagia was rarely caused or made more severe by the procedure; if present before the operation, it was relieved in most patients. The prevalence of persistent postoperative dysphagia was similar in patients with and without a motility abnormality. The success of Nissen fundoplication in properly selected patients is not affected by the presence of a nonspecific motility disorder.
Bremner
R M
RM
University of Southern California School of Medicine, Department of Surgery, Los Angeles 90033-4612.
DeMeester
T R
TR
Crookes
P F
PF
Costantini
M
M
Hoeft
S F
SF
Peters
J H
JH
Hagen
J
J
D003680:Deglutition Disorders / Q000453:epidemiology; D015154:Esophageal Motility Disorders / Q000453:epidemiology*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005748:Gastric Fundus / Q000601:surgery*; D005764:Gastroesophageal Reflux / Q000453:epidemiology / Q000601:surgery*; D006356:Heartburn / Q000453:epidemiology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D015995:Prevalence; D013997:Time Factors; D016896:Treatment Outcome