Nissen fundoplication gives lasting relief from symptoms of gastro-oesophag
eal reflux and cures endoscopic oesophagitis effectively. The histological
effect on the oesophageal mucosa is less clear. We studied the long-term hi
stological effect of Nissen fundoplication on refractory gastro-oesophageal
disease with erosive oesophagitis or Barrett's metaplasia in 33 patients w
ith biopsy both before and after antireflux surgery. The median postoperati
ve interval to re-examination was 80 (range 37-110) months. Symptoms of ref
lux were greatly relieved; 31 (94%) of the 33 patients had none or, at the
most, mild symptoms. Endoscopic oesophagitis was healed in 26 (79%) of the
cases. The histological appearance of the oesophageal mucosa had been abnor
mal in all the patients preoperatively, but at follow-up it was normal in 2
2 cases (67%): in 89% of the patients without objectively observed recurren
t reflux and in 45% of those with recurrence. Both the pre- and postoperati
ve severity of the histological changes correlated significantly with the e
ndoscopic grade of oesophagitis (r = 0.42, P = 0.017 and r = 0.837, P = 0.0
001, respectively), but not with the clinical reflux score. In conclusion,
Nissen fundoplication resulted in histological healing in the great majorit
y of patients with oesophagitis.