Long-term effect of fundoplication on motility of the oesophagus and oesophagogastric junction

Abstract

Abstract Background This study assessed the long-term effect of Nissen fundoplication on oesophageal and oesophagogastric junction (OGJ) motility. Methods Symptoms were scored and oesophageal manometry performed in 34 consecutive patients with chronic gastro-oesophageal reflux disease, before, 3 months after and 2 years after surgery. Results Distal peristaltic amplitude increased from a median of 57 (95 per cent confidence interval (c.i.) 18 to 107) mmHg to 86 (95 per cent c.i. 54 to 208) mmHg (P < 0·001) at 3 months and 92 (45 to 210) mmHg (P < 0·001) at 2 years. In four patients the amplitude increased to more than 180 mmHg and three of these patients reported odynophagia. After surgery, a linear relationship was observed between the peristaltic amplitude and nadir OGJ relaxation pressure at 3 months (rs = 0·68, P < 0·001) and 2 years (rs = 0·64, P < 0·001). A significant correlation was also found between amplitude and both basal OGJ pressure and intrabolus pressure at 3 months (rs = 0·58, P < 0·001 and rs = 0·63, P < 0·001 respectively) and 2 years (rs = 0·71, P < 0·001 and rs = 0·49, P = 0·024). There was a relationship between peristaltic amplitude and the odynophagia score at 2 years (rs = 0·60, P = 0·017). Conclusion Within 3 months of fundoplication the amplitude of oesophageal peristalsis increased substantially, leading to a nutcracker oesophagus and odynophagia in a subgroup of patients. These phenomena did not appear to progress with time.