Long-term effect of fundoplication on motility of the oesophagus and oesophagogastric junction.
BACKGROUND
This study assessed the long-term effect of Nissen fundoplication on oesophageal and oesophagogastric junction (OGJ) motility.


METHODS
Symptoms were scored and oesophageal manometry performed in 34 consecutive patients with chronic gastro-oesophageal reflux disease, before, 3 months after and 2 years after surgery.


RESULTS
Distal peristaltic amplitude increased from a median of 57 (95 per cent confidence interval (c.i.) 18 to 107) mmHg to 86 (95 per cent c.i. 54 to 208) mmHg (P < 0.001) at 3 months and 92 (45 to 210) mmHg (P < 0.001) at 2 years. In four patients the amplitude increased to more than 180 mmHg and three of these patients reported odynophagia. After surgery, a linear relationship was observed between the peristaltic amplitude and nadir OGJ relaxation pressure at 3 months (r(s) = 0.68, P < 0.001) and 2 years (r(s) = 0.64, P < 0.001). A significant correlation was also found between amplitude and both basal OGJ pressure and intrabolus pressure at 3 months (r(s) = 0.58, P < 0.001 and r(s) = 0.63, P < 0.001 respectively) and 2 years (r(s) = 0.71, P < 0.001 and r(s) = 0.49, P = 0.024). There was a relationship between peristaltic amplitude and the odynophagia score at 2 years (r(s) = 0.60, P = 0.017).


CONCLUSIONS
Within 3 months of fundoplication the amplitude of oesophageal peristalsis increased substantially, leading to a nutcracker oesophagus and odynophagia in a subgroup of patients. These phenomena did not appear to progress with time.
Scheffer
R C H
RC
Gastrointestinal Research Unit, Departments of Surgery and Gastroenterology, University Medical Centre Utrecht, Utrecht, The Netherlands.
Samsom
M
M
Frakking
T G
TG
Smout
A J P M
AJ
Gooszen
H G
HG
D003680:Deglutition Disorders / Q000503:physiopathology / Q000601:surgery; D004943:Esophagogastric Junction / Q000503:physiopathology*; D005260:Female; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000503:physiopathology / Q000601:surgery*; D005769:Gastrointestinal Motility / Q000502:physiology*; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D010528:Peristalsis / Q000502:physiology; D011446:Prospective Studies