title: Postprandial bloating after laparoscopic Nissen fundoplication.
abstract: OBJECTIVE
  To evaluate the prevalence and possible contributing factors to postprandial bloating in patients having chronic gastroesophageal reflux disease (GERD) before and after laparoscopic Nissen fundoplication.
  
  
  METHODS
  A prospective cohort study.
  
  
  METHODS
  A tertiary care teaching hospital.
  
  
  METHODS
  Five hundred and seventy-eight patients with proven GERD.
  
  
  METHODS
  Laparoscopic Nissen fundoplication.
  
  
  METHODS
  Symptom severity scores for postprandial bloating and dysphagia, esophageal motility and 24-hour pH measurement before and at 6 months, 2 years and 5 years after laparoscopic Nissen fundoplication.
  
  
  RESULTS
  Of the 598 patients, 436 (73%) reported some postprandial bloating before the procedure. The symptom score for bloating significantly improved after surgery (p < 0.0001). There were no significant differences in the lower esophageal sphincter basal pressures or 24-hour pH scores between those who reported improvement or worsening of their postprandial bloating. At 6 months after surgery, 54% of patients experienced postprandial bloating; of these, 49% reported improvement, 21% reported worsening and 30% reported no change in bloating symptoms compared with the preoperative state. Of the patients who reported worsening of postprandial bloating 6 months after surgery, 86 were reassessed 2 years after surgery and 71% reported improvement of this symptom over this time interval.
  
  
  CONCLUSIONS
  Bloating is a common symptom in patients who suffer from chronic GERD. Laparoscopic Nissen fundoplication lessens the severity of this symptom in most patients. In a small subgroup of patients, antireflux surgery may exacerbate the bloating, but this improves over time.
authors.affiliation: Department of Surgery, St. Joseph's Hospital, McMaster University, Hamilton, Ont. anvari@mcmaster.ca
authors.forename: M
authors.initials: M
authors.lastname: Anvari
authors.forename: C
authors.initials: C
authors.lastname: Allen
mesh_terms: D003680:Deglutition Disorders / Q000209:etiology; D005260:Female; D018662:Fundoplication / Q000009:adverse effects*; D005740:Gases; D005764:Gastroesophageal Reflux / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D019518:Postprandial Period; D011446:Prospective Studies; D013270:Stomach / Q000503:physiopathology*
chemical_list: D005740:Gases