Abstracts
2000 Digestive Disease Week

# 2264 Lower Esophageal Sphincter Residual Pressure Is Related to Dysphagia or Recurrent Reflux After Nissen Fundoplication.
Anna Kaminski, Reginald V. Lord, Peter F. Crookes, Cedric G. Bremner, Dennis Blom, Michael G. Wood, David J. Bowrey, Saj Wajed, Rodney Mason, Steven R. Demeester, Jeffrey H. Peters, Tom R. Demeester, Los Angeles, CA

Aims: To investigate the mechanism of action of antireflux surgery and to determine whether postoperative dysphagia or recurrent GERD after antireflux surgery are associated with LES relaxation characteristics. Methods: We reviewed the clinical and motility records of 100 symptomatic patients who were investigated 26±30 months after Nissen fundoplication. Patients with a named esophageal motility disorder or a median distal esophageal amplitude < 20 mmHg were excluded. Factors studied were symptoms of heartburn or dysphagia graded on a scale of 0- 3), age, interval from operation to investigation, LES resting measurements (pressure, overall length, and intra-abdominal length) and LES relaxation measurements (residual pressure, nadir pressure, duration of relaxation, time to residual pressure) and 24 hr pH monitoring results. Comparison groups were normal volunteers who did not undergo Nissen fundoplication and 22 post-Nissen fundoplication research volunteers with minor symptoms. Results: 59 of the 100 study patients complained of postoperative dysphagia, whereas only 14% of the post-Nissen research volunteers had any dysphagia. Patients with moderately severe or severe dysphagia (score of 2 or more, n=29) had significantly higher residual LES pressures compared to patients with no or only mild dysphagia (6.9 mm Hg vs 10 mm Hg, p<0.0005) The resting LES pressure was also significantly higher (p=0.006). The other factors were not significantly associated with the presence of dysphagia. Patients with abnormal percent time

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