Does oesophageal motor function improve with time after successful antireflux surgery? Results of a prospective, randomised clinical study.

作者：Lars Rydberg, Merlin Shalini Ruth, Lars R. Lundell · 发表于：Gut · 年份：1997 · DOI：10.1136/gut.41.1.82 · 被引用次数：72 · 研究领域：Gastroesophageal reflux and treatments、Esophageal Cancer Research and Treatment、Gastrointestinal motility and disorders

MAIN OBJECTIVE: There is a continuing debate whether motor abnormalities associated with gastro-oesophageal reflux disease (GORD) are primary phenomena or occur as a consequence of repeated injury caused by inflammation. To get new insights into mechanisms involved, patients were studied before and three years after effective and durable reflux control induced by two types of fundoplications. PATIENTS AND METHODS: Thirty three consecutive patients with chronic GORD entered the trial. All patients had a clinical history of GORD assessed symptomatically, endoscopically, and by use of 24 hour pH-metry. Eighteen were randomised to a 180 degrees semifundoplication (Toupet) and 15 to a total fundic wrap (Nissen-Rossetti). Manometry was done preoperatively, six months, and three years after the operation assessing motor function in defined areas of the tubular oesophagus and lower oesophageal sphincter. RESULTS: All patients had a proper control of GORD both when objectively and clinically assessed. Postoperatively, the resting tone of the lower oesophageal sphincter was significantly higher in the Nissen-Rossetti group (p < 0.05), and the intra-abdominal portion of the lower oesophageal sphincter was of identical length in the two groups. A significant increase in peristaltic amplitude in the middle and distal third of the oesophagus was recorded at long term follow up compared with the preoperative findings (p < 0.05), but there was no corresponding effect on propagation speed and...