ESOPHAGEAL PH MONITORING OF POSTPRANDIAL GASTROESOPHAGEAL REFLUX - COMPARISON BETWEEN HEALTHY-SUBJECTS, PATIENTS WITH GASTROESOPHAGEAL REFLUX AND PATIENTS TREATED WITH NISSEN FUNDOPLICATION

To analyze postprandial gastroesophageal reflux by means of ambulatory gastroesophageal pH monitoring for 24 h, four groups were studied pro spectively: group A: 22 healthy volunteers; group B: 31 consecutive pa tients undergoing medical treatment for gastroesophageal reflux, group C1: 20 consecutive patients with symptomatic reflux awaiting surgical treatment by means of Nissen fundoplication (pre-Nissen evaluation) a nd group C2: group C1 patients reevaluated 6 months postoperatively (p ost-Nissen evaluation). Gastro-esophageal pH, as a measure of post-pra ndial reflux following the main meal of the day was evaluated by the K aye test. In groups B, C1 and C2, esophageal manometry was also perfor med. Gastroesophageal pH monitoring revealed significant qualitative a s well as quantitative differences in postprandial gastroesophageal re flux experienced by healthy subjects (group A) and surgically treated patients (group C2) compared to patients with pathologic reflux (group s B and C1). The postprandial reflux was significantly more acid and m ore important (Kaye's test value) in groups C1 and B than in groups A and C2. There were no differences in postprandial reflux between healt hy subjects and patients treated by Nissen fundoplication (group C2). Only the pressure and length of the lower esophageal sphincter (LES) s howed differences after Nissen fundoplication. We conclude that patien ts with pathologic reflux have more severe postprandial reflux than no rmal subjects; Nissen fundoplication corrects the degree of postprandi al reflux to a normal range by elevating the LES pressure(l 1.3x1.4 vs . 22.4+/-1.6 mm Hg; p<0.001)and length (2.7+/-0.2 vs. 3.7+/-0.1 cm; p< 0.001) in our patients.