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Long‐term effect of fundoplication on motility of the oesophagus and oesophagogastric junction

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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).

Conclusion:

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. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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Document Type: Research Article

Affiliations: Gastrointestinal Research Unit, Departments of Surgery and Gastroenterology, University Medical Centre Utrecht, Utrecht, The Netherlands

Publication date: November 1, 2004

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