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Acid normalization and improved esophageal motility after Nissen fundoplication: equivalent outcomes in patients with normal and ineffective esophageal motility.
Am J Surg 2005; 190(3):445-50AJ

Abstract

BACKGROUND

Severe gastroesophageal reflux disease may result in acquired esophageal dysmotility. The correct surgical approach to associated gastroesophageal reflux disease and dysmotility is controversial, in particular whether the "gold-standard" total fundoplication of Nissen is appropriate compared with partial fundoplication. Our unit has performed total fundoplication for all patients, irrespective of esophageal motility, and this article describes that experience.

METHODS

Ninety-eight patients undergoing antireflux surgery were divided into 2 groups. Group 1 (n=60) consisted of patients with normal esophageal motility, and group 2 (n=38) had dysmotility. All patients underwent preoperative and postoperative manometry, 24-hour pH testing, symptom scoring, and quality-of-life assessment.

RESULTS

The median postoperative acid score was not significantly different between groups 1 and 2. Eighty-eight percent of patients with normal motility and 89% of patients with dysmotility had no symptoms or minor symptoms, with a significant improvement in quality of life 6 months after surgery. There was a significant increase in esophageal wave amplitude in both groups, and 20 patients (53%) in the dysmotility group reverted to normal motility after surgery. Recurrent symptoms were associated with postoperative abnormal pH profiles in 5 patients from group 1 and 3 from group 2.

CONCLUSIONS

Preoperative dysmotility is not a contraindication for total fundoplication. Postoperative acid control is associated with improved esophageal clearance and symptoms.

Authors+Show Affiliations

University Department of Surgery, St James' Hospital, Dublin 8, Ireland.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

16105534

Citation

Ravi, Narayanasamy, et al. "Acid Normalization and Improved Esophageal Motility After Nissen Fundoplication: Equivalent Outcomes in Patients With Normal and Ineffective Esophageal Motility." American Journal of Surgery, vol. 190, no. 3, 2005, pp. 445-50.
Ravi N, Al-Sarraf N, Moran T, et al. Acid normalization and improved esophageal motility after Nissen fundoplication: equivalent outcomes in patients with normal and ineffective esophageal motility. Am J Surg. 2005;190(3):445-50.
Ravi, N., Al-Sarraf, N., Moran, T., O'Riordan, J., Rowley, S., Byrne, P. J., & Reynolds, J. V. (2005). Acid normalization and improved esophageal motility after Nissen fundoplication: equivalent outcomes in patients with normal and ineffective esophageal motility. American Journal of Surgery, 190(3), pp. 445-50.
Ravi N, et al. Acid Normalization and Improved Esophageal Motility After Nissen Fundoplication: Equivalent Outcomes in Patients With Normal and Ineffective Esophageal Motility. Am J Surg. 2005;190(3):445-50. PubMed PMID: 16105534.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acid normalization and improved esophageal motility after Nissen fundoplication: equivalent outcomes in patients with normal and ineffective esophageal motility. AU - Ravi,Narayanasamy, AU - Al-Sarraf,Nael, AU - Moran,Tracey, AU - O'Riordan,James, AU - Rowley,Suzanne, AU - Byrne,Patrick J, AU - Reynolds,John V, PY - 2004/12/09/received PY - 2005/05/02/revised PY - 2005/05/02/accepted PY - 2005/8/18/pubmed PY - 2005/9/28/medline PY - 2005/8/18/entrez SP - 445 EP - 50 JF - American journal of surgery JO - Am. J. Surg. VL - 190 IS - 3 N2 - BACKGROUND: Severe gastroesophageal reflux disease may result in acquired esophageal dysmotility. The correct surgical approach to associated gastroesophageal reflux disease and dysmotility is controversial, in particular whether the "gold-standard" total fundoplication of Nissen is appropriate compared with partial fundoplication. Our unit has performed total fundoplication for all patients, irrespective of esophageal motility, and this article describes that experience. METHODS: Ninety-eight patients undergoing antireflux surgery were divided into 2 groups. Group 1 (n=60) consisted of patients with normal esophageal motility, and group 2 (n=38) had dysmotility. All patients underwent preoperative and postoperative manometry, 24-hour pH testing, symptom scoring, and quality-of-life assessment. RESULTS: The median postoperative acid score was not significantly different between groups 1 and 2. Eighty-eight percent of patients with normal motility and 89% of patients with dysmotility had no symptoms or minor symptoms, with a significant improvement in quality of life 6 months after surgery. There was a significant increase in esophageal wave amplitude in both groups, and 20 patients (53%) in the dysmotility group reverted to normal motility after surgery. Recurrent symptoms were associated with postoperative abnormal pH profiles in 5 patients from group 1 and 3 from group 2. CONCLUSIONS: Preoperative dysmotility is not a contraindication for total fundoplication. Postoperative acid control is associated with improved esophageal clearance and symptoms. SN - 0002-9610 UR - https://www.unboundmedicine.com/medline/citation/16105534/Acid_normalization_and_improved_esophageal_motility_after_Nissen_fundoplication:_equivalent_outcomes_in_patients_with_normal_and_ineffective_esophageal_motility_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9610(05)00497-6 DB - PRIME DP - Unbound Medicine ER -