Esophageal motility in reflux disease before and after fundoplication: A prospective, randomized, clinical, and manometric study

Background & Aims: The purpose of this study was to determine whether esoph ageal dysmotility affects symptoms of gastroesophageal reflux disease or cl inical outcome after laparoscopic fundoplication and whether esophagus moto r function changes postoperatively. Methods: Two hundred patients with a hi story of longstanding gastroesophageal reflux disease weve investigated by clinical assessment, upper gastrointestinal endoscopy, esophageal manometry , and 24-hour pH monitoring between May 1999 and May 2000. Patients were st ratified according to presence or absence of esophageal dysmotility teach n = 100) and randomized to either 360 degrees (Nissen) or 270 degrees (Toupe t) fundoplication. At a 4-month postoperative follow-up, preoperative tests were repeated. Results: Preoperative esophageal dysmotility was associated with move severe reflux symptoms, more frequent resistance to medical trea tment (64% vs. 49%; P < 0.05), and greater decrease in lower esophageal sph incter pressure (9.5 +/- 5.3 vs. 12.4 +/- 6.7 mm Hg; P < 0.0005) compared w ith normal motility. Postoperatively, clinical outcome and reflux recurrenc e (21% vs. 14%) were similar. Esophageal motility remained unchanged in 85% of patients and changed from pathologic to normal in 20 (10 Nissen/10 Toup et) and vice versa in 9 (8 Nissen/1 Toupet) patients. Conclusions: Esophage al dysmotility (1) reflects move severe disease; (2) does not affect postop erative clinical outcome; (3) is not corrected by fundoplication, independe nt of the surgical procedure performed; (4) may occur as a result of fundop lication; and (5) requires no tailoring of surgical management.