NISSEN FUNDOPLICATION FOR REFLUX ESOPHAGITIS - LONG-TERM CLINICAL ANDENDOSCOPIC RESULTS IN 109 OF 127 CONSECUTIVE PATIENTS

Objective This study evaluates the clinical and endoscopic long-term r esults of Nissen fundoplication in reflux esophagitis. Summary Backgro und Data Nissen fundoplication has been reported to give good results in the treatment of gastro esophageal reflux with success rates up to 78-97%. Most of the previous studies on long-term results of fundoplic ation have, however, been based on interviews with only sporadic endos copic examinations. Methods Of 127 patients consecutively treated with Nissen fundoplication for reflux esophagitis, 109 were available for follow-up after a median of 77 months. Upper gastrointestinal endoscop y was done in 105 cases, and all the patients with reflux symptoms or abnormal endoscopic observations were referred to esophageal 24-hour p H monitoring and manometry. Results No symptoms of gastroesophageal re flux were reported by 73 of the 109 patients, but dysphagia was presen t in 47. Endoscopy showed defective fundic wrap in 24 patients. Object ive evidence of reflux was found in 24 patients (endoscopic esophagiti s in 18 and pathologic 24-hour pH score without esophagitis in 6). Eso phagitis was found in 14 of the 24 patients with defective wrap, but i n only 4 of the 81 with infact wrap. Conclusions Nissen fundoplication alleviated symptoms of gastroesophageal reflux and cured esophagitis in great majority of cases. The main determinant of outcome was the st ate of the fundic wrap.