Altered esophageal sensory–motor function in patients with persistent symptoms after Nissen fundoplication

Abstract

Background The pathophysiology of persistent gastroesophageal reflux disease (GERD) symptoms after antireflux surgery is unclear. We assessed esophageal sensorimotor function in patients with GERD before and after Nissen fundoplication (NF). Methods Sensory and biomechanical properties were evaluated before surgery using impedance planimetry in 17 GERD patients and 16 healthy volunteers. All patients underwent standard laparoscopic NF. Eight GERD patients with persistent symptoms after surgery underwent repeat evaluations at least 12 months after surgery. Results At baseline, GERD patients had lower thresholds for first perception ( P < .001), discomfort ( P < .001), and pain ( P < .001) compared with controls. The esophagus was more reactive ( P = .001) and less distensible ( P = .04) in patients than controls. After NF, in patients with persistent symptoms, the sensory thresholds were unchanged ( P > .05) but esophageal wall reactivity decreased ( P = .001), and distensibility improved ( P = .025). Conclusions NF improves esophageal biomechanical dysfunction but not the underlying hypersensitivity. Visceral hypersensitivity of the esophagus may explain persistent symptoms after NF.