Impaired Bolus Transit Across the Esophagogastric Junction in Postfundoplication Dysphagia

Scheffer, R. C. H.; Samsom, M.; Haverkamp, A.; Oors, J.; Hebbard, G. S.; Gooszen, H. G.
August 2005
American Journal of Gastroenterology;Aug2005, Vol. 100 Issue 8, p1677
Academic Journal
OBJECTIVES: This study assessed the effect of fundoplication on liquid and solid bolus transit across the esophagogastric junction (EGJ) in relation to EGJ dynamics and dysphagia. METHODS: Twelve patients with gastro-esophageal reflux disease (GERD) were studied before and after fundoplication. Concurrent high-resolution EGJ manometry and fluoroscopy were performed whilst swallowing liquid barium and a solid bolus. The EGJ transit time, EGJ opening duration, transit efficacy, and EGJ relaxation were measured. During the test symptoms of dysphagia were scored using a visual analog scale. RESULTS: The minimal opening aperture at fluoroscopy was located at the manometric EGJ in all subjects. Fundoplication markedly reduced the EGJ opening diameter from 1.0 ± 0.1 to 0.6 ± 0.1 cm ( p < 0.01) and rendered deglutative EGJ relaxation incomplete. After fundoplication, a higher intrabolus pressure was found ( p < 0.05) associated with a reduced axial bolus length ( p < 0.001). EGJ transit time increased from 6.9 ± 0.9 to 9.8 ± 1.0 s for liquids ( p < 0.01) and from 2.8 ± 0.5 to 5.8 ± 0.8 s ( p < 0.01) for solids after fundoplication. No relation between EGJ transit and dysphagia scores was observed before fundoplication. In contrast, EGJ transit time significantly correlated with dysphagia scores both during liquid (r = 0.84; p < 0.01) and solid (r = 0.69; p < 0.05) bolus transit following fundoplication. CONCLUSIONS: Fundoplication patients exhibit a restricted hiatal opening and an incomplete deglutative EGJ relaxation. To facilitate EGJ transit despite these altered EGJ dynamics a higher intrabolus pressure is created by augmented bolus compression. Fundoplication increases EGJ transit time, the degree of which is associated with postoperative dysphagia. (Am J Gastroenterol 2005;100:1677–1684)


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