title: Impaired bolus transit across the esophagogastric junction in postfundoplication dysphagia.
abstract: OBJECTIVE
  This study assessed the effect of fundoplication on liquid and solid bolus transit across the esophagogastric junction (EGJ) in relation to EGJ dynamics and dysphagia.
  
  
  METHODS
  Twelve patients with gastro-esophageal reflux disease (GERD) were studied before and after fundoplication. Concurrent high-resolution EGJ manometry and fluoroscopy were performed whilst swallowing liquid barium and a solid bolus. The EGJ transit time, EGJ opening duration, transit efficacy, and EGJ relaxation were measured. During the test symptoms of dysphagia were scored using a visual analog scale.
  
  
  RESULTS
  The minimal opening aperture at fluoroscopy was located at the manometric EGJ in all subjects. Fundoplication markedly reduced the EGJ opening diameter from 1.0 +/- 0.1 to 0.6 +/- 0.1 cm (p < 0.01) and rendered deglutative EGJ relaxation incomplete. After fundoplication, a higher intrabolus pressure was found (p < 0.05) associated with a reduced axial bolus length (p < 0.001). EGJ transit time increased from 6.9 +/- 0.9 to 9.8 +/- 1.0 s for liquids (p < 0.01) and from 2.8 +/- 0.5 to 5.8 +/- 0.8 s (p < 0.01) for solids after fundoplication. No relation between EGJ transit and dysphagia scores was observed before fundoplication. In contrast, EGJ transit time significantly correlated with dysphagia scores both during liquid (r = 0.84; p < 0.01) and solid (r = 0.69; p < 0.05) bolus transit following fundoplication.
  
  
  CONCLUSIONS
  Fundoplication patients exhibit a restricted hiatal opening and an incomplete deglutative EGJ relaxation. To facilitate EGJ transit despite these altered EGJ dynamics a higher intrabolus pressure is created by augmented bolus compression. Fundoplication increases EGJ transit time, the degree of which is associated with postoperative dysphagia.
authors.affiliation: Gastrointestinal Research Unit, Departments of Surgery and Gastroenterology, University Medical Center, Utrecht, the Netherlands.
authors.forename: R C H
authors.initials: RC
authors.lastname: Scheffer
authors.forename: M
authors.initials: M
authors.lastname: Samsom
authors.forename: A
authors.initials: A
authors.lastname: Haverkamp
authors.forename: J
authors.initials: J
authors.lastname: Oors
authors.forename: G S
authors.initials: GS
authors.lastname: Hebbard
authors.forename: H G
authors.initials: HG
authors.lastname: Gooszen
mesh_terms: D000328:Adult; D003679:Deglutition; D003680:Deglutition Disorders / Q000209:etiology / Q000503:physiopathology*; D004943:Esophagogastric Junction / Q000503:physiopathology*; D005260:Female; D005471:Fluoroscopy; D018662:Fundoplication / Q000009:adverse effects*; D005764:Gastroesophageal Reflux / Q000601:surgery; D041981:Gastrointestinal Tract; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged