A prospective study of effects of Belsey MK IV antireflux surgery on endoscopic esophagitis, lower esophageal sphincter pressure, and 24-hr pH measurements. Relation to symptom improvement.
A prospective study on the effect of the Belsey MK IV operation on esophagitis, lower esophageal sphincter pressure (LESP), and acid reflux as monitored on 24-hr pH recording was conducted to investigate the association between objective changes and the effect of operation on reflux-associated symptoms. Thirty-one patients were included. The effect of surgery on symptoms was recorded in all patients, and 22 patients agreed to undergo endoscopy, manometry, and 24-hr pH recording. Follow-up ranged from three to nine years (mean five years); 87% reported long-lasting improvement (50% free of symptoms, 37% major improvement, no medication needed). The combination of symptomatic improvement and absence of esophagitis was found in 70%. LESP significantly increased [8 +/- 6 mm Hg preoperatively, 14 +/- 5 mm Hg postoperatively (P < 0.001)] to a level above 5 mm Hg in 96% of the patients. No endoscopic esophagitis was found in 17 of 20 patients (85%; P < 0.05) (two patients refused endoscopy). The 24-hr pH monitoring normalized in 11 of the 20 patients (55%) (one registration failed). The operation-induced rise in LESP correlated with improvement on endoscopy (r = 0.51; P < 0.002) and with reduction of reflux parameters (number of episodes with pH < 4: r = 0.64; P < 0.05, percentage of total time pH < 4: r = 0.42; P = 0.07). A rise in LESP must be an important aim of antireflux surgery. The Belsey MK IV does not induce a rise to a level that causes severe dysphagia or bloating, but the trade-off is less control of acid reflux.(ABSTRACT TRUNCATED AT 250 WORDS)
Horbach
J M
JM
Department of Surgery, University Hospital Leiden, The Netherlands.
Cnossen
M H
MH
Jansen
J B
JB
Lamers
C B
CB
Zwinderman
A H
AH
Terpstra
J L
JL
Gooszen
H G
HG
D000328:Adult; D000368:Aged; D004942:Esophagitis, Peptic / Q000473:pathology / Q000601:surgery*; D004943:Esophagogastric Junction / Q000503:physiopathology*; D004945:Esophagoscopy; D005260:Female; D005764:Gastroesophageal Reflux / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D011312:Pressure; D011379:Prognosis; D011446:Prospective Studies; D013997:Time Factors