Gastroesophageal disease and nausea - Does fundoplication help or hurt?

Hypothesis: Nausea associated with gastroesophageal reflux disease is cured by laparoscopic Nissen fundoplication (LNF). Design: Prospective cohort study of unselected patients who underwent LNF f rom January 1, 1995, through March 31, 1999. Patients were followed up by a physician for 6 to 36 months. Setting: A large community teaching hospital. Patients: One hundred consecutive patients with gastroesophageal reflux: di sease who underwent LNF; all patients were followed up. Patients were group ed according to the presence (group A, n = 33) or absence (group B, n = 67) of preoperative nausea. Interventions were LNF, esophageal manometry, 24-h our pH monitoring, and nuclear gastric emptying studies. Main Outcome Measures: Resolution of symptoms after LNF. Results: Nausea was the most common atypical symptom of gastroesophageal re flux disease, occurring in 33 patients (33%). There were no differences in esophageal manometry or 24-hour pH results between groups. There was a fema le preponderance in group A (55% vs 33%; P = .003). Patients in group A had a higher prevalence of preoperative dysphagia (P = .02). Patients with per sistent postoperative nausea had a higher prevalence of cough (P = .003) an d dysphagia (P = .009). The LNF was more effective in reducing heartburn (9 5% reduction) and regurgitation (95% reduction) than cough and dysphagia (6 0% reduction). There was a 79% reduction in the number of patients with nau sea (33 to 7; P<.001). Conclusion: Laparoscopic Nissen fundoplication is effective in eliminating nausea associated with gastroesophageal reflux disease and is not contraind icated in these patients.