Prognostic value of the lower esophageal sphincter gradient and acid exposure in the follow-up of antireflux operations

Eighty-eight consecutive patients with antireflux fundoplication had manome try and pH recording pre- and post-operatively at 6 months and 1, 3 and 5 y ears for a mean follow-up of 30.6 months. Failure occurred in nine patients (11.4%), For the whole group of patients, surgery produced a significant i ncrease in the lower esophageal sphincter (LES) pressure gradient from 9.5 +/- 6.3 to 14.6 +/- 6.7 mmHg and a significant decrease in acid exposure fr om 20.6% +/- 17.6% to 5.5% +/- 8.8% at 6 months. There was a similar change in pressure (p < 0.0005) and pH (p < 0.002) in the successful but not in t he failure group, Over time, the values remained stable in both groups. Pos t-operative LES pressure was significantly correlated with the outcome at 6 months (p < 0.02), and the pH was inversely correlated at 5 years(p < 0.03 9). This study confirms the early predictive value of the post-operative LE S pressure, Esophageal acid exposure remains a reliable marker of the outco me, However, recurrences remain unexplained by LES pressure measurement and long-term follow-up using manometry and pH recording does not bring additi onal valuable data.