Abstracts
2000 Digestive Disease Week

# 2257 The Myth of Dysphagia After Antireflux Surgery: Analysis of Swallowing Difficulty in Patients with GERD.
Dennis Blom, David J. Bowrey, Jeffrey H. Peters, Tom R. Demeester, Peter F. Crookes, Reginald V. Lord, Michael G. Wood, Christopher Streets, Saj Wajed, Jeffrey A. Hagen, Steve R. Demeester, Cedric G. Bremner, Los Angeles, CA

INTRODUCTION: Laparoscopic Nissen fundoplication (LN) has become the surgical treatment of choice for gastroesophageal reflux disease (GERD). Many believe dysphagia occurs commonly after Nissen fundoplication. The aims of this study are to determine the incidence of dysphagia in GERD, after LN and the variables that predict dysphagia before and after LN. METHODS: 161 patients with documented GERD, median age 48 years (range 15-78), 118 men and 43 women underwent LN between 1991 and 1999. Median follow up was 14 mo. (range 6-81) Dysphagia was assessed using a standard scoring system: 0=asymptomatic, 1=occasional not requiring diet modification, 2=moderate requiring diet modification only, 3=severe requiring medical intervention. Variables predicting dysphagia were evaluated by logistic regression analysis and the Fisher s exact test and included age, sex, esophageal and LES manometric characteristics, ambulatory pH, endoscopic findings and preoperative symptoms. RESULTS: Moderate to severe dysphagia was present in 37% (60/161) prior to surgery. In 7% (12/161) it was the primary symptom. Regression analysis revealed an association with female sex (p=0.01) and the presence of a stricture (p=0.02). Dysphagia was relieved or improved in 92% (55/60) and persistent in 8% (5/60). New dysphagia developed in only 6 patients after LN. None of the preoperative variables evaluated predicted postoperative dysphagia. CONCLUSION: Dysphagia is a common complaint in patients with GERD. Greater than 90% of patients will be relieved of this symptom after LN. The development of de novo dysphagia is rare. Current preoperative diagnostic modalities appear inadequate in predicting those patients at risk for postoperative dysphagia. This study does not support the belief that LN causes dysphagia and provides further evidence that preoperative dysphagia is usually relieved by antireflux surgery.