Motor and sensory function of the proximal stomach in reflux disease and after laparoscopic Nissen fundoplication

OBJECTIVE: After Nissen fundoplication, dyspeptic symptoms such as fullness and early satiety develop in >30% of patients. These symptoms may result f rom alterations in proximal gastric motor and sensory function. METHODS: We have evaluated proximal gastric motor and sensory function usin g an electronic barostat in 12 patients after successful laparoscopic Nisse n fundoplications (median follow-up; 12 months). Twelve age- and gender-mat ched patients with severe gastroesophageal reflux disease (GERD) and 12 hea lthy volunteers served as controls. Studies were performed in the fasting s tate and after meal ingestion. Gastric emptying tests were performed in all patients. Vagus nerve integrity was measured by the response of pancreatic polypeptide CPP) to insulin hypoglycemia. RESULTS: Minimal distending pressure and proximal gastric compliance were n ot significantly different between post-Nissen patients, GERD patients, and healthy controls. Postprandial relaxation of the stomach, however, was sig nificantly (p < 0.05) reduced post-Nissen (267 +/- 34 ml), compared with co ntrols (400 +/- 30 ml) and GERD (448 +/- 30 ml). Postprandial relaxation wa s significantly (p < 0.01) prolonged in GERD patients. Postprandial relaxat ion of the stomach correlated with gastric emptying of solids (r = 0.62; p = 0.01). Gastric emptying of solids became significantly (p < 0.05) faster after fundoplication. Postprandial fullness was significantly (p < 0.05) in creased in the operated patients. CONCLUSIONS: Post-Nissen patients have a significantly reduced postprandial gastric relaxation and significantly accelerated gastric emptying, which m ay explain postoperative dyspeptic symptoms. The abnormalities result from fundoplication and not from vagus nerve injury or reflux per se, because in reflux patients gastric relaxation and gastric emptying are prolonged. (Am J Gastroenterol 1999;94: 1481-1489. (C) 1999 by Am. Coll. of Gastroenterol ogy).