Pressure morphology of the gastroesophageal junction after fundoplication: How normal is it

Abstract

Though effective in resolving esophagitis, fundoplication (FP) can impair belching, a venting mechanism that requires both a relaxed sphincter an d that intragastric pressure exceed extrasphincteric pressure. To better understand this limitation, we compared gastroesophageal junction (GEJ) pressure morphology after FP to that of normal volunteers (N1) and hiatal hernia (HH) patients. Methods: Metal clips were placed endoscopically to mark the intragastric margin of the GEJ and squamocolumnar junction (SCJ) in 7 Nls, 7 HH patients, and 7 patients after FP. GEJ pressure (0=atmospheric) referenced to the clips and hiatus was measured during concurrent videofluoroscopy and mechanized pull through of an 8-lumen manometer with radiopaque side holes at the same axial level but 45 ° apart radially. Subdiaphragmatic length (SDL) of the GEJ (shaded area in figure) was that distal to the hiatal canal, as localized in HH patients. Pull throughs were done during endexpiration, deep inspiration, and abdominal compression (AC) with a binder inflated to 100 mmHg. Results: Axial position of the SCJ was restored post-FP, but GEJ pressure morphology of each group was distinct (Figure & Table, All data mean -+ SE).