title: Long-term effects of anti-reflux surgery on the physiology of the esophagogastric junction.
abstract: BACKGROUND
  Studies performed shortly after anti-reflux surgery have demonstrated that the reduction of reflux episodes is caused by a decrease in the rate of transient lower esophageal sphincter relaxations (TLESRs) and a decrease in the distensibility of the esophagogastric junction (EGJ). We aimed to assess the long-term effects of surgical fundoplication on the physiology of the EGJ.
  
  
  METHODS
  We included 18 patients who underwent surgical fundoplication >5 years before and 10 GERD patients who did not have surgery. Patients underwent 90-min combined high-resolution manometry and pH-impedance monitoring, and EGJ distensibility was assessed.
  
  
  RESULTS
  Post-fundoplication patients exhibited a lower frequency of reflux events than GERD patients (2.0 ± 0.5 vs 15.1 ± 4.3, p < 0.05). The rate of TLESRs (6.1 ± 0.9 vs 12.6 ± 1.0, p < 0.05) and their association with reflux (28.3 ± 9.0 vs 74.9 ± 6.9 %, p < 0.05) was lower in post-fundoplication patients than in GERD patients. EGJ distensibility was significantly lower in post-fundoplication patients than in GERD patients. Recurrence of GERD symptoms after fundoplication was not associated with an increased number of reflux episodes, nor was it associated with an increased distensibility of the EGJ or an increase in the number of TLESRs.
  
  
  CONCLUSIONS
  More than 5 years after anti-reflux surgery, patients still exhibit a lower rate of TLESRs and a reduced distensibility of the EGJ compared with medically treated GERD patients. These data suggest that the effects of surgical fundoplication on EGJ physiology persist at the long term and underlie the persistent reduction of reflux events.
authors: Department of Gastroenterology and Hepatology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. bkessing@gmail.com.
authors: Boudewijn F
authors: BF
authors: Kessing
authors: Department of Gastroenterology and Hepatology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors: Albert J
authors: AJ
authors: Bredenoord
authors: Department of Surgery, Academic Medical Center, Amsterdam, Netherlands.
authors: Marlies P
authors: MP
authors: Schijven
authors: Department of Surgery, VU University Medical Center, Amsterdam, Netherlands.
authors: Donald L
authors: DL
authors: van der Peet
authors: Department of Surgery, Academic Medical Center, Amsterdam, Netherlands.
authors: Mark I
authors: MI
authors: van Berge Henegouwen
authors: Department of Gastroenterology and Hepatology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors: André J P M
authors: AJ
authors: Smout
mesh_terms: D000328:Adult; D000368:Aged; D050782:Esophageal pH Monitoring; D004943:Esophagogastric Junction / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: Esophagus; Fundoplication; GERD; pH monitoring