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. 1997 Jul;41(1):82–86. doi: 10.1136/gut.41.1.82

Does oesophageal motor function improve with time after successful antireflux surgery? Results of a prospective, randomised clinical study.

L Rydberg 1, M Ruth 1, L Lundell 1
PMCID: PMC1027233  PMID: 9274477

Abstract

MAIN OBJECTIVE: There is a continuing debate whether motor abnormalities associated with gastro-oesophageal reflux disease (GORD) are primary phenomena or occur as a consequence of repeated injury caused by inflammation. To get new insights into mechanisms involved, patients were studied before and three years after effective and durable reflux control induced by two types of fundoplications. PATIENTS AND METHODS: Thirty three consecutive patients with chronic GORD entered the trial. All patients had a clinical history of GORD assessed symptomatically, endoscopically, and by use of 24 hour pH-metry. Eighteen were randomised to a 180 degrees semifundoplication (Toupet) and 15 to a total fundic wrap (Nissen-Rossetti). Manometry was done preoperatively, six months, and three years after the operation assessing motor function in defined areas of the tubular oesophagus and lower oesophageal sphincter. RESULTS: All patients had a proper control of GORD both when objectively and clinically assessed. Postoperatively, the resting tone of the lower oesophageal sphincter was significantly higher in the Nissen-Rossetti group (p < 0.05), and the intra-abdominal portion of the lower oesophageal sphincter was of identical length in the two groups. A significant increase in peristaltic amplitude in the middle and distal third of the oesophagus was recorded at long term follow up compared with the preoperative findings (p < 0.05), but there was no corresponding effect on propagation speed and duration of contraction. However, an increase in peristaltic amplitude and, as a tentative consequence, a significant decrease (p < 0.05) in the frequency of primary peristalsis was found only in patients operated on with a total fundic wrap. CONCLUSION: Despite adequate and durable reflux control after fundoplication in patients with chronic GORD, no change was found in oesophageal motor function with time. The higher contraction amplitude and decreased frequency of failed primary peristalsis seen in patients having a total fundic wrap were thus most likely due to a mechanical outflow obstruction in the gastro-oesophageal junction. These results could therefore be interpreted in favour of the hypothesis that GORD is pathogenetically linked to a primary defect in oesophageal motor function.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Allen M. L., McIntosh D. L., Robinson M. G. Healing or amelioration of esophagitis does not result in increased lower esophageal sphincter or esophageal contractile pressure. Am J Gastroenterol. 1990 Oct;85(10):1331–1334. [PubMed] [Google Scholar]
  2. Biancani P., Barwick K., Selling J., McCallum R. Effects of acute experimental esophagitis on mechanical properties of the lower esophageal sphincter. Gastroenterology. 1984 Jul;87(1):8–16. [PubMed] [Google Scholar]
  3. Biancani P., Billett G., Hillemeier C., Nissensohn M., Rhim B. Y., Szewczak S., Behar J. Acute experimental esophagitis impairs signal transduction in cat lower esophageal sphincter circular muscle. Gastroenterology. 1992 Oct;103(4):1199–1206. doi: 10.1016/0016-5085(92)91504-w. [DOI] [PubMed] [Google Scholar]
  4. Cook I. J., Gabb M., Panagopoulos V., Jamieson G. G., Dodds W. J., Dent J., Shearman D. J. Pharyngeal (Zenker's) diverticulum is a disorder of upper esophageal sphincter opening. Gastroenterology. 1992 Oct;103(4):1229–1235. doi: 10.1016/0016-5085(92)91508-2. [DOI] [PubMed] [Google Scholar]
  5. DeMeester T. R., Bonavina L., Albertucci M. Nissen fundoplication for gastroesophageal reflux disease. Evaluation of primary repair in 100 consecutive patients. Ann Surg. 1986 Jul;204(1):9–20. doi: 10.1097/00000658-198607000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Dent J. A new technique for continuous sphincter pressure measurement. Gastroenterology. 1976 Aug;71(2):263–267. [PubMed] [Google Scholar]
  7. Eastwood G. L., Castell D. O., Higgs R. H. Experimental esophagitis in cats impairs lower esophageal sphincter pressure. Gastroenterology. 1975 Jul;69(1):146–153. [PubMed] [Google Scholar]
  8. Gill R. C., Bowes K. L., Murphy P. D., Kingma Y. J. Esophageal motor abnormalities in gastroesophageal reflux and the effects of fundoplication. Gastroenterology. 1986 Aug;91(2):364–369. doi: 10.1016/0016-5085(86)90570-6. [DOI] [PubMed] [Google Scholar]
  9. Higgs R. H., Castell D. O., Eastwood G. L. Studies on the mechanism of esophagitis-induced lower esophageal sphincter hypotension in cats. Gastroenterology. 1976 Jul;71(1):51–56. [PubMed] [Google Scholar]
  10. Howard J. M., Reynolds R. P., Frei J. V., Flowers M. A., McDonald T. J., Tilbe K., Bondy D. C. Macroscopic healing of esophagitis does not improve esophageal motility. Dig Dis Sci. 1994 Mar;39(3):648–654. doi: 10.1007/BF02088355. [DOI] [PubMed] [Google Scholar]
  11. Ireland A. C., Holloway R. H., Toouli J., Dent J. Mechanisms underlying the antireflux action of fundoplication. Gut. 1993 Mar;34(3):303–308. doi: 10.1136/gut.34.3.303. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Jacob P., Kahrilas P. J., Vanagunas A. Peristaltic dysfunction associated with nonobstructive dysphagia in reflux disease. Dig Dis Sci. 1990 Aug;35(8):939–942. doi: 10.1007/BF01537240. [DOI] [PubMed] [Google Scholar]
  13. Kahrilas P. J., Dodds W. J., Hogan W. J. Effect of peristaltic dysfunction on esophageal volume clearance. Gastroenterology. 1988 Jan;94(1):73–80. doi: 10.1016/0016-5085(88)90612-9. [DOI] [PubMed] [Google Scholar]
  14. Kahrilas P. J., Dodds W. J., Hogan W. J., Kern M., Arndorfer R. C., Reece A. Esophageal peristaltic dysfunction in peptic esophagitis. Gastroenterology. 1986 Oct;91(4):897–904. doi: 10.1016/0016-5085(86)90692-x. [DOI] [PubMed] [Google Scholar]
  15. Lundell L., Abrahamsson H., Ruth M., Rydberg L., Lönroth H., Olbe L. Long-term results of a prospective randomized comparison of total fundic wrap (Nissen-Rossetti) or semifundoplication (Toupet) for gastro-oesophageal reflux. Br J Surg. 1996 Jun;83(6):830–835. doi: 10.1002/bjs.1800830633. [DOI] [PubMed] [Google Scholar]
  16. Lundell L., Abrahamsson H., Ruth M., Sandberg N., Olbe L. C. Lower esophageal sphincter characteristics and esophageal acid exposure following partial or 360 degrees fundoplication: results of a prospective, randomized, clinical study. World J Surg. 1991 Jan-Feb;15(1):115–121. doi: 10.1007/BF01658980. [DOI] [PubMed] [Google Scholar]
  17. Maddern G. J., Jamieson G. G. Oesophageal emptying in patients with gastro-oesophageal reflux. Br J Surg. 1986 Aug;73(8):615–617. doi: 10.1002/bjs.1800730809. [DOI] [PubMed] [Google Scholar]
  18. Martinez de Haro L., Parrilla Paricio P., Ortíz Escandell M. A., Morales Cuenca G., Videla Troncoso D., Cifuentes Tebar J., Garay Pelegrin V. Antireflux mechanism of Nissen fundoplication. A manometric study. Scand J Gastroenterol. 1992 May;27(5):417–420. doi: 10.3109/00365529209000098. [DOI] [PubMed] [Google Scholar]
  19. Mughal M. M., Bancewicz J., Marples M. Oesophageal manometry and pH recording does not predict the bad results of Nissen fundoplication. Br J Surg. 1990 Jan;77(1):43–45. doi: 10.1002/bjs.1800770115. [DOI] [PubMed] [Google Scholar]
  20. Ortiz Escandell A., Martinez de Haro L. F., Parrilla Paricio P., Aguayo Albasini J. L., Garcia Marcilla J. A., Morales Cuenca G. Surgery improves defective oesophageal peristalsis in patients with gastro-oesophageal reflux. Br J Surg. 1991 Sep;78(9):1095–1097. doi: 10.1002/bjs.1800780919. [DOI] [PubMed] [Google Scholar]
  21. Russell C. O., Pope C. E., 2nd, Gannan R. M., Allen F. D., Velasco N., Hill L. D. Does surgery correct esophageal motor dysfunction in gastroesophageal reflux. Ann Surg. 1981 Sep;194(3):290–296. doi: 10.1097/00000658-198109000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Russell C. O., Whelan G. Oesophageal manometry: how well does it predict oesophageal function. Gut. 1987 Aug;28(8):940–945. doi: 10.1136/gut.28.8.940. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Singh P., Adamopoulos A., Taylor R. H., Colin-Jones D. G. Oesophageal motor function before and after healing of oesophagitis. Gut. 1992 Dec;33(12):1590–1596. doi: 10.1136/gut.33.12.1590. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Stein H. J., Bremner R. M., Jamieson J., DeMeester T. R. Effect of Nissen fundoplication on esophageal motor function. Arch Surg. 1992 Jul;127(7):788–791. doi: 10.1001/archsurg.1992.01420070040010. [DOI] [PubMed] [Google Scholar]
  25. Timmer R., Breumelhof R., Nadorp J. H., Smout A. J. Oesophageal motility and gastro-oesophageal reflux before and after healing of reflux oesophagitis. A study using 24 hour ambulatory pH and pressure monitoring. Gut. 1994 Nov;35(11):1519–1522. doi: 10.1136/gut.35.11.1519. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Timmer R., Breumelhof R., Nadorp J. H., Smout A. J. Oesophageal motor response to reflux is not impaired in reflux oesophagitis. Gut. 1993 Mar;34(3):317–320. doi: 10.1136/gut.34.3.317. [DOI] [PMC free article] [PubMed] [Google Scholar]

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