Histological improvement of oesophagitis after Nissen fundoplication

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.