Impaired postoperative EGJ relaxation as a determinant of post laparoscopic fundoplication dysphagia: a study with high-resolution manometry before and after surgery

Marjoux, Sophie; Roman, Sabine; Juget-Pietu, Florence; Robert, M.; Poncet, Gilles; Boulez, J.; Mion, François

doi:10.1007/s00464-012-2388-z

Cited by 39 publications

(39 citation statements)

References 32 publications

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“…[1][2][3] Scheffer et al 5 found increased intra-bolus pressure (IBP) and increased esophagogastric junction (EGJ) relaxation pressure in patients after fundoplication. Recent studies conducted by Marjoux et al 6 included pre-and post-operative analysis of Chicago classification parameters which showed mainly EGJ resting pressure improvement with frequent EGJ relaxation impairment leading to simultaneous motility disorders in post-fundoplication patients. Effective esophageal motility determines esophageal clearance, which is of particular significance for patients with GERD qualified for antireflux surgery.…”

Section: Introductionmentioning

confidence: 99%

“…Fundoplication is the "gold standard" for GERD treatment as an alternative to pharmacological therapy in PPI non-responders, or when PPI long term therapy is not suitable. 5,6,9 By re-establishing successful EGJ resting pressure and hiatal hernia repair, fundoplication eliminates mechanical factors responsible for reflux events, providing effective and long-term heartburn control in 90% of the patients. Fundoplication not only enhances the EGJ barrier but also alters esophageal motility.…”

Section: Introductionmentioning

confidence: 99%

“…However, in spite of good reflux control results, up to 90% of post-fundoplication patients report dysphagia during the first 3 months after surgery, which resolves gradually within 5 years following the surgery. 5,6,10,11 Clinical relevance of HRM findings in post-operative patients with complications still remains poorly understood. It was suggested that the disordered esophageal motor function can be an underlying cause of dysphagia and chest pain.…”

Section: Introductionmentioning

confidence: 99%

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High-resolution Manometry in Patients with Gastroesophageal Reflux Disease Before and After Fundoplication

Rerych

Kurek²,

Klimacka-Nawrot

et al. 2017

J Neurogastroenterol Motil

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Background/AimsThe study aimed to determine pre-and post-fundoplication esophagogastric junction (EGJ) pressure and esophageal peristalsis by high-resolution manometry (HRM) in patients with gastroesophageal reflux disease (GERD). MethodsPre-operative and post-operative HRM data from 25 patients with GERD were analyzed using ManoView version 2.0.1. with updated software for Chicago classification and pressure topography. The study involved swallowing water boluses of 10 mL in the upright position. ResultsSignificant increase of mean basal EGJ pressure and minimal basal EGJ pressure was found in post-operative as compared with preoperative patients (P < 0.05 and P < 0.001, respectively). Integrated relaxation pressure (IRP) reached higher values in post-operative patients than in pre-operative patients (P < 0.001). Intra-bolus pressure (IBP) was significantly higher (P < 0.05) and contractile front velocity (CFV) was slower (P < 0.01) in post-operative patients than in pre-operative patients. Moreover significant increase of distal contractile integral (DCI) was found in post-operative patients (P < 0.05). Hiatal hernia was detected by HRM in 11 pre-operative patients. Fifteen out of 25 post-operative patients complained of dysphagia. ConclusionsFundoplication restores the antireflux barrier by reinforcing EGJ basal pressures, repairing hiatal hernias, and enhances peristaltic function of the esophagus by increasing DCI. However slight IRP elevation found in post-fundoplication patients may result in bolus pressurization and motility disorders.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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High-resolution Manometry in Patients with Gastroesophageal Reflux Disease Before and After Fundoplication

Rerych

Kurek²,

Klimacka-Nawrot

et al. 2017

J Neurogastroenterol Motil

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“…26 Additional problems such as diarrhea and gas-bloating have been reported. 9,27,28 Due to the risks of postoperative complications, many patients dissatisfied with PPI therapy are reluctant to undergo this procedure. Several alternative options for the treatment of GERD have been introduced during the last 2 decades.…”

Section: Discussionmentioning

confidence: 99%

“…Currently, 18 patients have completed 3-month follow-up and 14 patients 6-month follow-up. Interim results showed a positive ef- fect on symptoms: GERD-HRQL median (IQR) score was 4 (2-11) at 3 months and 5 (4-9) at 6 months, respectively with P < 0.001 and P < 0.01 when compared to baseline score off PPI (31 [25][26][27][28][29][30][31][32][33][34][35][36][37]). Furthermore, acid exposure time decreased from 11.3% (9.0-15.5%) at baseline to 3.3% (2.5-9.1%) at 3 months and to 2.6% (1.8-5.4%) at 6 months (Fig.…”

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confidence: 99%

Electrical Stimulation Therapy for Gastroesophageal Reflux Disease

Rinsma

Bouvy

Masclee

et al. 2014

J Neurogastroenterol Motil

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Electrical stimulation therapy (EST) of the lower esophageal sphincter is a relatively new technique for the treatment of gastroesophageal reflux disease (GERD) that may address the need of GERD patients, unsatisfied with acid suppressive medication and concerned with the potential risks of surgical fundoplication. In this paper we review available data about EST for GERD, including the development of the technique, implant procedure, safety and results from open-label trials. Two short-term temporary stimulation and long-term open-label human trials each were initiated to investigate the safety and efficacy of EST for the treatment of GERD and currently up to 2 years follow-up results are available. The results of EST are promising as the open-label studies have shown that EST is a safe technique with a significant improvement in both subjective outcomes of symptoms and objective outcomes of esophageal acid exposure in patients with GERD. However, long-term data from larger number of patients and a sham-controlled trial are required before EST can be conclusively advised as a viable treatment option for GERD patients.

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Manometric identikit of a functioning and effective fundoplication for gastroesophageal reflux disease in the high‐resolution manometry ERA

Salvador,

Capovilla,

Santangelo

et al. 2024

UEG Journal

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BackgroundThe pathophysiological and clinical value of performing High‐Resolution Manometry (HRM) after laparoscopic fundoplication (LF) for gastroesophageal reflux disease (GERD) is still unclear and debated.ObjectiveWe sought to establish the HRM parameters indicative of functioning fundoplications, and whether HRM could distinguish them from tight or defective ones.MethodsThe study involved patients with GERD who underwent laparoscopic Nissen (LN) or Toupet (LT) fundoplication between 2010 and 2022. HRM and 24‐h pH monitoring were performed before and 6 months after surgery. The study population was divided into 5 groups: LN and LT patients with normal 24h‐pH findings (LNpH‐ and LTpH‐, respectively); LN and LT patients with pathological 24h‐pH findings (LNpH+ and LTpH + groups, respectively); and patients with a postoperative dysphagia intensity score >2 (Dysphagia group). The novel Hiatal Morphology (HM) classification was applied, envisaging 3 different subtypes: HM1 (normal), HM2 (intrathoracic fundoplication), and HM3 (slipped fundoplication).ResultsAmong the 132 patients recruited during the study period, 46 were in the LNpH‐ group, 51 in the LTpH‐ group, 15 in the LNpH + group, 7 in the LTpH + group, and 5 in the Dysphagia group. In multivariate analysis, postoperative abdominal lower esophageal sphincter length (p = 0.001) and HM2 (p < 0.001) were both independently associated with surgical failure. Integrated relaxation pressure was significantly higher in the Dysphagia group than in the LNpH‐ group.ConclusionThis study generated reference HRM values for an effective LF, and confirms that using HRM to assess the neo‐sphincter and HM improves the clinical assessment in cases of symptom recurrence.

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Impaired postoperative EGJ relaxation as a determinant of post laparoscopic fundoplication dysphagia: a study with high-resolution manometry before and after surgery

Cited by 39 publications

References 32 publications

High-resolution Manometry in Patients with Gastroesophageal Reflux Disease Before and After Fundoplication

High-resolution Manometry in Patients with Gastroesophageal Reflux Disease Before and After Fundoplication

Electrical Stimulation Therapy for Gastroesophageal Reflux Disease

Manometric identikit of a functioning and effective fundoplication for gastroesophageal reflux disease in the high‐resolution manometry ERA

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