The American Journal of Surgery
Volume 193, Issue 2 , Pages 200-205, February 2007

Altered esophageal sensory–motor function in patients with persistent symptoms after Nissen fundoplication

  • Jose M. Remes-Troche, M.D.

      Affiliations

    • Section of Neurogastroenterology, Division of Gastroenterology–Hepatology, Department of Internal Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Dr, 4612 JCP, Iowa City, IA 52242, USA
    • ,
  • James Maher, M.D.

      Affiliations

    • Department of Surgery, Virginia Commonwealth University, Richmond, VA
    • ,
  • Ranjit Mudipalli, M.D.

      Affiliations

    • Section of Neurogastroenterology, Division of Gastroenterology–Hepatology, Department of Internal Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Dr, 4612 JCP, Iowa City, IA 52242, USA
    • ,
  • Satish S.C. Rao, M.D., Ph.D., F.R.C.P. (LON)

      Affiliations

    • Section of Neurogastroenterology, Division of Gastroenterology–Hepatology, Department of Internal Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Dr, 4612 JCP, Iowa City, IA 52242, USA
    • Corresponding Author InformationCorresponding author. Tel.: +1-319-353-6602; fax: +1-319-353-6399.

Received 25 August 2006; received in revised form 30 October 2006

Abstract 

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.

Keywords: Esophagus, Nissen fundoplication, refractory GERD, Sensorimotor function

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PII: S0002-9610(06)00716-1

doi:10.1016/j.amjsurg.2006.10.013

The American Journal of Surgery
Volume 193, Issue 2 , Pages 200-205, February 2007

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