TY - JOUR
T1 - Altered esophageal sensory-motor function in patients with persistent symptoms after Nissen fundoplication
AU - Remes-Troche, Jose M.
AU - Maher, James
AU - Mudipalli, Ranjit
AU - Rao, Satish S.C.
N1 - Copyright:
Copyright 2008 Elsevier B.V., All rights reserved.
PY - 2007/2
Y1 - 2007/2
N2 - Background: The pathophysiology of persistent gastroesophageal reflux disease (GERD) symptoms after antireflux surgery is unclear. We assessed esophageal sensorimotor function in patients with GERD before and after Nissen fundoplication (NF). Methods: Sensory and biomechanical properties were evaluated before surgery using impedance planimetry in 17 GERD patients and 16 healthy volunteers. All patients underwent standard laparoscopic NF. Eight GERD patients with persistent symptoms after surgery underwent repeat evaluations at least 12 months after surgery. Results: At baseline, GERD patients had lower thresholds for first perception (P < .001), discomfort (P < .001), and pain (P < .001) compared with controls. The esophagus was more reactive (P = .001) and less distensible (P = .04) in patients than controls. After NF, in patients with persistent symptoms, the sensory thresholds were unchanged (P > .05) but esophageal wall reactivity decreased (P = .001), and distensibility improved (P = .025). Conclusions: NF improves esophageal biomechanical dysfunction but not the underlying hypersensitivity. Visceral hypersensitivity of the esophagus may explain persistent symptoms after NF.
AB - Background: The pathophysiology of persistent gastroesophageal reflux disease (GERD) symptoms after antireflux surgery is unclear. We assessed esophageal sensorimotor function in patients with GERD before and after Nissen fundoplication (NF). Methods: Sensory and biomechanical properties were evaluated before surgery using impedance planimetry in 17 GERD patients and 16 healthy volunteers. All patients underwent standard laparoscopic NF. Eight GERD patients with persistent symptoms after surgery underwent repeat evaluations at least 12 months after surgery. Results: At baseline, GERD patients had lower thresholds for first perception (P < .001), discomfort (P < .001), and pain (P < .001) compared with controls. The esophagus was more reactive (P = .001) and less distensible (P = .04) in patients than controls. After NF, in patients with persistent symptoms, the sensory thresholds were unchanged (P > .05) but esophageal wall reactivity decreased (P = .001), and distensibility improved (P = .025). Conclusions: NF improves esophageal biomechanical dysfunction but not the underlying hypersensitivity. Visceral hypersensitivity of the esophagus may explain persistent symptoms after NF.
KW - Esophagus
KW - Nissen fundoplication
KW - Sensorimotor function
KW - refractory GERD
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U2 - 10.1016/j.amjsurg.2006.10.013
DO - 10.1016/j.amjsurg.2006.10.013
M3 - Article
C2 - 17236847
AN - SCOPUS:33846247375
SN - 0002-9610
VL - 193
SP - 200
EP - 205
JO - American Journal of Surgery
JF - American Journal of Surgery
IS - 2
ER -