Nissen-type fundoplication and its effects on the emetic reflex and gastric motility in the ferret

Recurrent vomiting with failure to thrive is a common problem in neurologic ally impaired children. Many undergo fundoplication to control the underlyi ng gastro-oesophageal reflux. The results of surgery are not always satisfa ctory and post-operative retching may be a major problem - a symptom indica tive of activation of the emetic reflex. An animal model of antireflux surg ery has been developed and used to investigate the effects of such surgery upon the emetic reflex and vagal influences on gastric motility. Following surgery, animals responded to a previously subemetic dose of a centrally ac ting opiate receptor agonist (loperamide), suggesting that fundoplication m ay sensitize the emetic reflex A gastric vago-vagal reflex (tonic inhibitio n of corpus tone) and responses to direct stimulation of vagal motor effere nts (both cholinergic and nonadrenergic noncholinergic responses) were not significantly affected by antireflux surgery. Mechanisms by which neural da mage may sensitize the emetic reflex are discussed, together with the possi ble clinical implications for the management of post-operative symptoms in neurologically impaired children.