title: Can different subsets of ineffective esophageal motility influence the outcome of nissen fundoplication?
abstract: BACKGROUND
  Ineffective esophageal motility (IEM) in patients with gastroesophageal reflux disease includes three different subsets that may affect symptom profiles. Our aim was to assess symptoms and functional outcome in patients with erosive esophagitis according to different subsets of IEM, before and after Nissen fundoplication (NF).
  
  
  METHODS
  A retrospective study with prospective follow-up of 72 patients with reflux esophagitis and IEM in whom open NF was performed. Based on principal manometric esophageal body motility disorder, patients were divided in three groups: predominantly low-amplitude (LAC, N = 38), non-propulsive (NPC, N = 18), and simultaneous low-amplitude esophageal contractions (SC, N = 16). Patients underwent symptomatic questionnaire and stationary esophageal manometry before and 6 months, 1 year, and 3 years after surgery.
  
  
  RESULTS
  Preoperatively, patients in NPC and SC groups had higher mean scores of dysphagia, without statistical significance as opposed to the LAC group (p = 0.239). Postoperative dysphagia occurred in 36 patients, without statistical significance between groups regarding dysphagia grades (p = 0.390). A longer duration of postoperative dysphagia was noted in the SC group (p < 0.05). Improvement of nadir values of contraction amplitudes in distal esophagus occurred postoperatively in all groups, significantly higher in LAC (p < 0.001).
  
  
  CONCLUSIONS
  Three years after NF, successful symptomatic and functional outcome was achieved in analyzed groups of patients with erosive esophagitis regardless of IEM subtype.
authors.affiliation: Department of Esophagogastric Surgery, First Surgical University Hospital, Clinical Center of Serbia, Koste Todorovica St 6, 11.000, Belgrade, Serbia, apsimic@med.bg.ac.rs.
authors.forename: Aleksandar P
authors.initials: AP
authors.lastname: Simić
authors.forename: Ognjan M
authors.initials: OM
authors.lastname: Skrobić
authors.forename: Richard R
authors.initials: RR
authors.lastname: Gurski
authors.forename: Vladimir M
authors.initials: VM
authors.lastname: Šljukić
authors.forename: Nenad R
authors.initials: NR
authors.lastname: Ivanović
authors.forename: Predrag M
authors.initials: PM
authors.lastname: Peško
mesh_terms: D015154:Esophageal Motility Disorders / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D004947:Esophagus / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D005769:Gastrointestinal Motility / Q000502:physiology*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011184:Postoperative Period; D011312:Pressure; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
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