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Motor and sensory function of the proximal stomach in reflux disease and after laparoscopic Nissen fundoplication.
Am J Gastroenterol 1999; 94(6):1481-9AJ

Abstract

OBJECTIVE

After Nissen fundoplication, dyspeptic symptoms such as fullness and early satiety develop in >30% of patients. These symptoms may result from alterations in proximal gastric motor and sensory function.

METHODS

We have evaluated proximal gastric motor and sensory function using an electronic barostat in 12 patients after successful laparoscopic Nissen fundoplications (median follow-up; 12 months). Twelve age- and gender-matched patients with severe gastroesophageal reflux disease (GERD) and 12 healthy volunteers served as controls. Studies were performed in the fasting state and after meal ingestion. Gastric emptying tests were performed in all patients. Vagus nerve integrity was measured by the response of pancreatic polypeptide (PP) to insulin hypoglycemia.

RESULTS

Minimal distending pressure and proximal gastric compliance were not significantly different between post-Nissen patients, GERD patients, and healthy controls. Postprandial relaxation of the stomach, however, was significantly (p < 0.05) reduced post-Nissen (267 +/- 34 ml), compared with controls (400 +/- 30 ml) and GERD (448 +/- 30 ml). Postprandial relaxation was significantly (p < 0.01) prolonged in GERD patients. Postprandial relaxation of the stomach correlated with gastric emptying of solids (r = 0.62; p = 0.01). Gastric emptying of solids became significantly (p < 0.05) faster after fundoplication. Postprandial fullness was significantly (p < 0.05) increased in the operated patients.

CONCLUSIONS

Post-Nissen patients have a significantly reduced postprandial gastric relaxation and significantly accelerated gastric emptying, which may explain postoperative dyspeptic symptoms. The abnormalities result from fundoplication and not from vagus nerve injury or reflux per se, because in reflux patients gastric relaxation and gastric emptying are prolonged.

Authors+Show Affiliations

Department of Gastroenterology-Hepatology, Leiden University Medical Center, The Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

10364011

Citation

Vu, M K., et al. "Motor and Sensory Function of the Proximal Stomach in Reflux Disease and After Laparoscopic Nissen Fundoplication." The American Journal of Gastroenterology, vol. 94, no. 6, 1999, pp. 1481-9.
Vu MK, Straathof JW, v d Schaar PJ, et al. Motor and sensory function of the proximal stomach in reflux disease and after laparoscopic Nissen fundoplication. Am J Gastroenterol. 1999;94(6):1481-9.
Vu, M. K., Straathof, J. W., v d Schaar, P. J., Arndt, J. W., Ringers, J., Lamers, C. B., & Masclee, A. A. (1999). Motor and sensory function of the proximal stomach in reflux disease and after laparoscopic Nissen fundoplication. The American Journal of Gastroenterology, 94(6), pp. 1481-9.
Vu MK, et al. Motor and Sensory Function of the Proximal Stomach in Reflux Disease and After Laparoscopic Nissen Fundoplication. Am J Gastroenterol. 1999;94(6):1481-9. PubMed PMID: 10364011.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Motor and sensory function of the proximal stomach in reflux disease and after laparoscopic Nissen fundoplication. AU - Vu,M K, AU - Straathof,J W, AU - v d Schaar,P J, AU - Arndt,J W, AU - Ringers,J, AU - Lamers,C B, AU - Masclee,A A, PY - 1999/6/11/pubmed PY - 1999/6/11/medline PY - 1999/6/11/entrez SP - 1481 EP - 9 JF - The American journal of gastroenterology JO - Am. J. Gastroenterol. VL - 94 IS - 6 N2 - OBJECTIVE: After Nissen fundoplication, dyspeptic symptoms such as fullness and early satiety develop in >30% of patients. These symptoms may result from alterations in proximal gastric motor and sensory function. METHODS: We have evaluated proximal gastric motor and sensory function using an electronic barostat in 12 patients after successful laparoscopic Nissen fundoplications (median follow-up; 12 months). Twelve age- and gender-matched patients with severe gastroesophageal reflux disease (GERD) and 12 healthy volunteers served as controls. Studies were performed in the fasting state and after meal ingestion. Gastric emptying tests were performed in all patients. Vagus nerve integrity was measured by the response of pancreatic polypeptide (PP) to insulin hypoglycemia. RESULTS: Minimal distending pressure and proximal gastric compliance were not significantly different between post-Nissen patients, GERD patients, and healthy controls. Postprandial relaxation of the stomach, however, was significantly (p < 0.05) reduced post-Nissen (267 +/- 34 ml), compared with controls (400 +/- 30 ml) and GERD (448 +/- 30 ml). Postprandial relaxation was significantly (p < 0.01) prolonged in GERD patients. Postprandial relaxation of the stomach correlated with gastric emptying of solids (r = 0.62; p = 0.01). Gastric emptying of solids became significantly (p < 0.05) faster after fundoplication. Postprandial fullness was significantly (p < 0.05) increased in the operated patients. CONCLUSIONS: Post-Nissen patients have a significantly reduced postprandial gastric relaxation and significantly accelerated gastric emptying, which may explain postoperative dyspeptic symptoms. The abnormalities result from fundoplication and not from vagus nerve injury or reflux per se, because in reflux patients gastric relaxation and gastric emptying are prolonged. SN - 0002-9270 UR - https://www.unboundmedicine.com/medline/citation/10364011/Motor_and_sensory_function_of_the_proximal_stomach_in_reflux_disease_and_after_laparoscopic_Nissen_fundoplication_ L2 - http://Insights.ovid.com/pubmed?pmid=10364011 DB - PRIME DP - Unbound Medicine ER -