Acid Reflux Research Today is a free monthly online journal that collates and summarizes the latest research about Acid Reflux, including details on diet, gerd (gastro-esophageal reflux disease), treatment, symptoms. | ||||||||
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Outcomes of Nissen fundoplication in patients with gastroesophageal reflux disease and delayed gastric emptying.Khajanchee YS, Dunst CM, Swanstrom LL Minimally Invasive Surgery Division, Legacy Health System, Portland, Oregon, USA. OBJECTIVE: To investigate the effect of delayed gastric emptying (DGE) on subjective and objective outcomes of gastroesophageal reflux disease following Nissen fundoplication with or without pyloroplasty. DESIGN: Retrospective analysis of prospectively collected data. SETTING: Tertiary care teaching hospital. PATIENTS: A total of 141 consecutive patients considered for Nissen fundoplication who also had suspected DGE based on symptoms. INTERVENTIONS: Of 141 patients, 63 had a time to 50% emptying (T(1/2)) greater than 90 minutes; 47 of the 63 of these had severe DGE (T(1/2) > 150 minutes) and had Nissen fundoplication and pyloroplasty. Sixteen of the 141 with T(1/2) greater than 90 but less than 150 minutes and 78 with normal gastric emptying findings (n = 78) had Nissen fundoplication only. MAIN OUTCOME MEASURES: Postoperatively, patients with symptom scores greater than 2 and/or abnormal 24-hour pH values (DeMeester score >14.7) were considered to have had unsuccessful treatment. Gastroesophageal reflux disease outcomes were compared between groups 1 and 2. Finally, the outcomes of both groups were compared with a control cohort of 418 patients with Nissen fundoplication and no DGE symptoms (group 3). RESULTS: At the mean follow-up of 21 months, there were no differences between the 2 groups regarding relief of reflux symptoms (DGE group, 54 of 63 [85.7%] vs NGE group, 71 of 78 [91%]; P = .47) or objective control of acid reflux (DGE group, 33 of 39 [84.6%] vs NGE group, 41 of 51 [80.3%]; P = .78). Dyspeptic symptoms were improved in the DGE group (P < .001); however, the overall incidence remained higher than the NGE group (P = .01). Postoperatively, T(1/2) normalized in 88.23% (15 of 17) of patients. Postoperative objective outcomes were also no different between these groups and patients with Nissen fundoplication who did not have DGE symptoms (n = 418). CONCLUSIONS: Delayed gastric emptying does not affect outcomes of gastroesophageal reflux disease following Nissen fundoplication, but patients with DGE have more postoperative gas and bloat and/or nausea compared with patients with normal gastric emptying; this is mostly corrected by addition of a pyloroplasty. Published 2 October 2009 in Arch Surg, 144(9): 823-8.
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