Nissen fundoplication improves gastric myoelectrical activity characteristics and symptoms in gastroesophageal reflux patients: evaluation in transcutaneous electrogastrography.
BACKGROUND
Gastric myoelectrical activity disorders play an essential role in the pathophysiology of gastroesophageal reflux disease (GERD), although little is known about gastric motility following surgical treatment of the disease. The aim of present study was to analyze the impact of Nissen fundoplication on both gastric myoelectrical activity, measured using the transcutaneous electrogastrography technique (EGG), and change in digestive symptoms.


METHODS
In 43 patients with GERD, EGG was recorded before and after the Nissen procedure and compared with the EGG obtained in eight healthy volunteers. Symptoms of epigastric pain, belching, regurgitation, heartburn, postprandial abdominal distension, and early satiety were recorded. At a three-week and a one-year postoperative follow-up, these tests were repeated.


RESULTS
In fasted patients before the operation, the slow-wave frequency distribution (normogastria, 53.7%; bradygastria, 44.2%; dysrhythmia, 47.1%) was significantly different compared with that of controls (89.2%, 7.0%, and 10.4%, respectively). No major changes in slow-wave frequency distribution were observed after a meal in examined patients, besides a significant rise in tachygastria (12.4%). Three weeks following the Nissen fundoplication, the fasting slow-wave frequency distribution did not change significantly compared with the preoperative period, being 58.1% for normogastria, 43.2% for bradygastria, and 12.0% for tachygastria. The abnormal distribution of slow waves (bradygastria + tachygastria) was not significantly affected by Nissen fundoplication, being 47.1% before and 44.9% after the operation, respectively. At the same time and still one year after operation there was a significant improvement in all clinical symptoms measured.


CONCLUSIONS
EGG showed that Nissen fundoplication influenced and might improve the slow-wave generation in gastric pacemaker. Dyspeptic symptoms were also improved up to one year postoperatively.
Wiesław
Tarnowski
T
Department of General and Gastroenterological Surgery, Orlowski's Hospital, MCPE, 231 Czerniakowska Street, 00-416, Warsaw, Poland. adamkic@yahoo.com
Adam
Kiciak
K
Artur
Binda
B
Lech
Baczuk
B
Krzysztof
Bielecki
B
D015746:Abdominal Pain / Q000453:epidemiology; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D016022:Case-Control Studies; D004415:Dyspepsia / Q000453:epidemiology; D004576:Electromyography; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000601:surgery*; D006356:Heartburn / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016065:Myoelectric Complex, Migrating / Q000502:physiology*; D011184:Postoperative Period; D019518:Postprandial Period; D011300:Preoperative Care; D015995:Prevalence; D011336:Probability; D012016:Reference Values; D012720:Severity of Illness Index; D016896:Treatment Outcome