Dysphagia after antireflux fundoplication: endoscopic,radiological and manometric evaluation

Background

The transient dysphagia after fundoplication is common and most often disappearsuntil six weeks postoperatively.

Aim

Analyze a group of patients who presented late and persistent dysphagiapostoperatively.

Methods

Forty-one patients after Nissen fundoplication, 14 male and 27 female, mean age 48year, were evaluated based on medical history, esophagogastroduodenoscopy,contrast radiographic examination and esophageal manometry. The results werecompared with another 19 asymptomatic individuals.

Results

Contrast radiographic examination of the esophagus revealed in six cases delayedemptying, characterizing that four patients had achalasia and two diffuse spasm ofthe esophagus. Esophageal manometry showed that maximal expiratory pressure of thelower sphincter ranged from 10 to 38 mmHg and mean respiratory pressure from 14 to47 mmHg, values similar to controls. Residual pressure ranged from 5 to 31 mmHg,and 17 patients had the same values as the control group.

Conclusion

The residual pressure of the lower sphincter was higher and statisticallysignificant in patients with dysphagia compared with those operated withoutdysphagia. Future studies individualizing and categorizing each motility disorder,employing other techniques of manometry, and the analysis of the residual pressuremay contribute to understand of persistent dysphagia in the postoperativefundoplication.