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

Jose M. Remes-Troche, James Maher, Ranjit Mudipalli, Satish S.C. Rao

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)200-205
Number of pages6
JournalAmerican Journal of Surgery
Volume193
Issue number2
DOIs
StatePublished - Feb 2007
Externally publishedYes

Keywords

  • Esophagus
  • Nissen fundoplication
  • Sensorimotor function
  • refractory GERD

ASJC Scopus subject areas

  • Surgery

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