PMID- 12049545
OWN - NLM
STAT- MEDLINE
DCOM- 20020712
LR  - 20190704
IS  - 0004-0010 (Print)
IS  - 0004-0010 (Linking)
VI  - 137
IP  - 6
DP  - 2002 Jun
TI  - Outcomes of laparoscopic Nissen fundoplication in patients with the 
      "hypercontractile esophagus".
PG  - 724-8, discussion 729
AB  - HYPOTHESIS: To determine if a hypercontractile esophagus, manifested by 
      high-amplitude peristaltic contractions (HAPCs) or hypertensive lower esophageal 
      sphincter (HLES), affects the outcome of antireflux surgery. DESIGN: Case series. 
      Prospectively maintained database. Direct contact with patients. Mean follow-up 
      28.7 months. SETTING: University hospital. PATIENTS: Of 643 patients who had 
      antireflux surgery for uncomplicated gastroesophageal reflux disease (GERD), 15 
      had HAPCs (> or = 150 mm Hg) and 4 HLES (> or = 45 mm Hg). INTERVENTION: 
      Laparoscopic Nissen fundoplication in all patients. MAIN OUTCOME MEASURES: (1) 
      Frequency of hypercontractile esophagus in patients considered for antireflux 
      procedure. (2) Effect of fundoplication on esophageal acid exposure and symptoms. 
      (3) Establish whether dysphagia or chest pain develop after fundoplication. 
      RESULTS: The typical GERD symptoms of heartburn and/or regurgitation occurred in 
      15 (79%) and 13 (69%) of 19 patients. Dysphagia was present in 5 of 15 patients 
      with HAPCs and in 0 of 4 with HLES; chest pain was found 5 of 15 patients with 
      HAPCs. After fundoplication acid exposure was improved in all (92%, 16/17) but 1 
      and was totally normal in 10 patients (83%). Heartburn improved in 11(78%) of 14 
      and resolved in 8 patients (57%) of the 14. Chest pain improved in 4 (80%) of the 
      5 patients who had it, and developed in 3 (23%) who did not have it 
      preoperatively. In patients with HAPCs, dysphagia improved in 4 (80%) of 5 
      patients with complete resolution in 3 (60%). New dysphagia developed in 2 (11%) 
      of the 19 patients, 1 in each group. No patient with HLES developed chest pain. 
      CONCLUSIONS: High-amplitude peristaltic contractions or HLES may be associated 
      with GERD in a subset of patients with dysphagia or chest pain. In such patients, 
      a Nissen fundoplication, by effectively controlling GERD, relieves these symptoms 
      in most patients. A hypercontractile esophagus in patients with GERD should not 
      be considered a contraindication to a total fundoplication. The surgeon and the 
      patient should be aware of the risk of developing chest pain after the operation.
FAU - Barreca, Marco
AU  - Barreca M
AD  - Department of Surgery, University of Washington, Seattle, USA.
FAU - Oelschlager, Brant K
AU  - Oelschlager BK
FAU - Pellegrini, Carlos A
AU  - Pellegrini CA
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Arch Surg
JT  - Archives of surgery (Chicago, Ill. : 1960)
JID - 9716528
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Chest Pain/etiology
MH  - Deglutition Disorders/etiology
MH  - Esophagus/*physiopathology
MH  - Female
MH  - *Fundoplication
MH  - Gastroesophageal Reflux/complications/*physiopathology/*surgery
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Peristalsis
MH  - Treatment Outcome
EDAT- 2002/06/07 10:00
MHDA- 2002/07/13 10:01
CRDT- 2002/06/07 10:00
PHST- 2002/06/07 10:00 [pubmed]
PHST- 2002/07/13 10:01 [medline]
PHST- 2002/06/07 10:00 [entrez]
AID - sws1020 [pii]
AID - 10.1001/archsurg.137.6.724 [doi]
PST - ppublish
SO  - Arch Surg. 2002 Jun;137(6):724-8, discussion 729. doi: 
      10.1001/archsurg.137.6.724.