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Comment
. 2001 Aug;234(2):139-46.
doi: 10.1097/00000658-200108000-00002.

Impact of delayed gastric emptying on the outcome of antireflux surgery

J E Bais  1 , M Samsom, E A Boudesteijn, P P van Rijk, L M Akkermans, H G Gooszen
Affiliations
Comment

Impact of delayed gastric emptying on the outcome of antireflux surgery

J E Bais et al. Ann Surg. 2001 Aug.

Abstract

Objective: To study the effect of Nissen fundoplication on the pattern of gastric emptying and intragastric distribution of symptoms in patients with normal and delayed gastric emptying before surgery, especially in those with delayed emptying before surgery.

Summary background data: Gastroesophageal reflux disease is associated with delayed gastric emptying and dyspeptic symptoms in approximately 40% of the patients. After Nissen fundoplication, dyspeptic symptoms are also not uncommon.

Methods: Thirty-six patients (26 men, 10 women, mean age 43.1) were studied before and 3 months after Nissen fundoplication. Gastric emptying (dual-isotope, expressed in lag phase, emptying rate, T50, and intragastric distribution) was not included in the decision for surgery. Reflux-related and dyspeptic symptoms were scored before and at 3, 6, and 12 months after surgery.

Results: Twenty-six patients had normal and 10 had delayed gastric emptying before surgery. Nissen fundoplication on average enhanced gastric emptying for solids in both subgroups by a combination of a decrease in mean lag phase, emptying rate, and T50. The preoperative difference in intragastric distribution between patients with and without delayed gastric emptying was abolished by fundoplication. Patients with normal gastric emptying before surgery showed an increase in early postprandial satiety; in those with delayed emptying, this was not observed. A correlation was found between preoperative T50 for liquid gastric emptying and postoperative nausea at 3 months in patients with normal gastric emptying. In patients with delayed emptying, preoperative correlations between lag phase for liquids and nausea respectively early satiety were significant, as well as for T50 for liquids and vomiting.

Conclusions: Nissen fundoplication equalizes the preoperative difference in intragastric distribution and accelerates gastric emptying without an effect on symptoms in patients with preexisting delayed gastric emptying, but with an increase in early satiety in patients with normal gastric emptying. Delayed gastric emptying is not a contraindication for antireflux surgery.

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Figures

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Figure 1. Parameters derived from time-activity curves to describe gastric emptying for a solid and a liquid meal.
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Figure 2. Mean (SD) gastrointestinal symptoms scores (0–5) in 26 patients with normal preoperative gastric emptying (solid meal), before and at 3, 6, and 12 months after Nissen fundoplication. Early satiety increased significantly 3 months after surgery (*P < .01).
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Figure 3. Mean (SD) gastrointestinal symptoms scores (0–5) in 10 patients with delayed preoperative gastric emptying (solid meal), before and at 3, 6, and 12 months after Nissen fundoplication.
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Figure 4. Gastric emptying for a solid meal (postlag emptying rate) in 26 patients with normal and 10 patients with delayed gastric emptying (%/h) before and after Nissen fundoplication. Normal range lies between dotted lines.
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Figure 5. The effect of Nissen fundoplication on the whole stomach (A), the gastric fundus (B), and the antrum (C).
See this image and copyright information in PMC

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References

    1. Little AG. Gastro-oesophageal reflux and oesophageal motility diseases. Who should perform antireflux surgery? Ann Chir Gynaecol 1995; 84: 103–105. - PubMed
    1. McCallum RW, Berkowitz DM, Lerner E. Gastric emptying in patients with gastroesophageal reflux. Gastroenterology 1981; 80: 285–291. - PubMed
    1. Schwizer W, Hinder RA, DeMeester TR. Does delayed gastric emptying contribute to gastroesophageal reflux disease? Am J Surg 1989; 157: 74–81. - PubMed
    1. Little AG, DeMeester TR, Kirchner PT, et al. Pathogenesis of esophagitis in patients with gastroesophageal reflux. Surgery 1980; 88: 101–107. - PubMed
    1. Maddern GJ, Chatterton BE, Collins PJ, et al. Solid and liquid gastric emptying in patients with gastro-oesophageal reflux. Br J Surg 1985; 72: 344–347. - PubMed