Abstracts
2002 Digestive Disease Week

# 102163 Abstract ID: 102163 Esophageal Dysmotility and Gastroesophageal Reflux Disease: Upper GI Can Predict Favorable Outcome after Laparoscopic Nissen Fundoplication
E Fraiji Jr, C Chambers, E Zervos, M Bloomston, S Goldin, M Wallace, Alexander S Rosemurgy II, Tampa, FL

Introduction: We undertook this study to determine if clearance of a food bolus at UGI contrast study predicts acceptable outcome after fundoplication in patients with gastroesophageal reflux disease (GERD) and esophageal dysmotility. Methods: Patients with GERD underwent 24 hour pH study and esophageal manometry. They were stratified into 3 groups by esophageal motility, which was graded by contraction amplitude(mm Hg) and propagation of wet swallows(%), as follows: normal motility (>60mmHg, >80%), moderate dysmotility (31-60mmHg, 51-80%), and severe dysmotility (<30mmHg, <50%). Patients with moderate or severe dysmotility underwent UGI with barium laden food bolus in 15° Trendelenburg position. Patients with normal motility and those with dysmotility able to clear a food bolus by UGI underwent laparoscopic Nissen fundoplication. Results: 100 randomly selected patients with normal motility were compared to 66 consecutive patients with dysmotility- 33 moderate/33 severe. Age, gender, and preoperative symptoms were not different among the three groups. Symptom scores were obtained utilizing a Likert scale (0=least severe to 10=most severe) and are reported as mean ? SD (Table). In each group the most common symptoms were heartburn, dysphagia and postprandial nausea. Postoperative symptom reduction was dramatic within all groups (P<0.01 Mann Whitney U test) except for postprandial nausea in patients with severe dysmotility, which was not remarkable preoperatively. There is no difference in patient satisfaction among groups (P<0.01,?2). Conclusion: Laparoscopic Nissen fundoplication relieves symptoms of GERD. Manometric esophageal dysmotility occurring with GERD can be further assessed by challenge with a barium laden food bolus. Patients with GERD and esophageal dysmotility who are able to clear a food bolus at UGI have satisfactory outcomes after fundoplication, similar to those with normal esophageal motility, and are not at increased risk for developing new or worsening dysphagia.