FUNCTION OF THE PROXIMAL STOMACH AFTER NISSEN FUNDOPLICATION

Background After Nissen fundoplication patients frequently report uppe r abdominal (dyspeptic) symptoms. Theoretically, these symptoms may be the result of changes in function of the proximal stomach as induced by fundoplication. Methods In this case-control study the response of the proximal stomach to both distension by an air-filled bag and a liq uid meal were evaluated with the use of a barostat. In 12 patients aft er fundoplication and 12 healthy volunteers (age-and sex-matched) perc eption of symptoms was evaluated during both bag distension and liquid meal stimulus. Results The minimal distending pressure required to ov ercome the intra-abdominal pressure was significantly different betwee n patients and controls (mean(s.e.m.) 9.34(0.26) versus 6.73(0.43) mmH g; P < 0.001). There was no difference between groups in either the fa sted state, volume-pressure curve (compliance) or total symptom score. After ingestion of the liquid meal the adaptive relaxation in the fun doplication group was significantly less than that in controls (mean(s .e.m.) 150(29.2) versus 244(34.8) ml; P = 0.04). Conclusion This study showed that after Nissen fundoplication compliance of the proximal st omach is no different from that in healthy volunteers. Postprandial re laxation of the proximal stomach is decreased and this abnormality may be involved in the pathogenesis of reported dyspeptic symptoms.