title: Impact of delayed gastric emptying on the outcome of antireflux surgery.
abstract: OBJECTIVE
  To study the effect of Nissen fundoplication on the pattern of gastric emptying and intragastric distribution of symptoms in patients with normal and delayed gastric emptying before surgery, especially in those with delayed emptying before surgery.
  
  
  BACKGROUND
  Gastroesophageal reflux disease is associated with delayed gastric emptying and dyspeptic symptoms in approximately 40% of the patients. After Nissen fundoplication, dyspeptic symptoms are also not uncommon.
  
  
  METHODS
  Thirty-six patients (26 men, 10 women, mean age 43.1) were studied before and 3 months after Nissen fundoplication. Gastric emptying (dual-isotope, expressed in lag phase, emptying rate, T50, and intragastric distribution) was not included in the decision for surgery. Reflux-related and dyspeptic symptoms were scored before and at 3, 6, and 12 months after surgery.
  
  
  RESULTS
  Twenty-six patients had normal and 10 had delayed gastric emptying before surgery. Nissen fundoplication on average enhanced gastric emptying for solids in both subgroups by a combination of a decrease in mean lag phase, emptying rate, and T50. The preoperative difference in intragastric distribution between patients with and without delayed gastric emptying was abolished by fundoplication. Patients with normal gastric emptying before surgery showed an increase in early postprandial satiety; in those with delayed emptying, this was not observed. A correlation was found between preoperative T50 for liquid gastric emptying and postoperative nausea at 3 months in patients with normal gastric emptying. In patients with delayed emptying, preoperative correlations between lag phase for liquids and nausea respectively early satiety were significant, as well as for T50 for liquids and vomiting.
  
  
  CONCLUSIONS
  Nissen fundoplication equalizes the preoperative difference in intragastric distribution and accelerates gastric emptying without an effect on symptoms in patients with preexisting delayed gastric emptying, but with an increase in early satiety in patients with normal gastric emptying. Delayed gastric emptying is not a contraindication for antireflux surgery.
authors.affiliation: Gastrointestinal Research Unit, University Medical Centre Utrecht University, Utrecht, The Netherlands.
authors.forename: J E
authors.initials: JE
authors.lastname: Bais
authors.forename: M
authors.initials: M
authors.lastname: Samsom
authors.forename: E A
authors.initials: EA
authors.lastname: Boudesteijn
authors.forename: P P
authors.initials: PP
authors.lastname: van Rijk
authors.forename: L M
authors.initials: LM
authors.lastname: Akkermans
authors.forename: H G
authors.initials: HG
authors.lastname: Gooszen
mesh_terms: D000328:Adult; D004415:Dyspepsia / Q000503:physiopathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication; D005746:Gastric Emptying / Q000502:physiology*; D005764:Gastroesophageal Reflux / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology*