Effect of laparoscopic fundoplication on hypertensive lower esophageal sphincter associated with gastroesophageal reflux

Gabor Varga, Agnes Kiraly, Laszlo Cseke, Katalin Kalmar, Ors Peter Horvath

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

For hypertensive lower esophageal sphincter with dysphagia and chest pain, a laparoscopic cardiomyotomy is recommended. Recently, the role of gastroesophageal reflux in this abnormality has been recognized. A prospective study on six patients with manometrically proven hypertensive lower esophageal sphincter was performed. Laparoscopic floppy Nissen fundoplication was performed in all cases. The first follow up was performed 6 weeks after the operation. The mean follow up time was 56 months (range 50-61). Before the operation, all patients had abnormal esophageal acid exposure. Mean DeMeester score was 41.7 (range 16.7-86). Average LES pressure before the operation was 50.5 mmHg (range 35.6-81.3). Six weeks after operation, all patients were symptom free. DeMeester score returned to a normal level of 2.9. Furthermore, a marked decrease in the lower esophageal sphincter pressure (24.7 mmHg) was detected. At late follow up, all patients were symptom-free, and only two patients agreed to undergo functional testing. The mean DeMeester score of this two patients was 1.2. The pressure remained at normal value (15.7 mmHg). In our study, an antireflux operation normalized lower esophageal sphincter pressure suggesting that abnormal esophageal acid exposure may be an etiologic factor in the development of hypertensive lower esophageal sphincter.

Original languageEnglish
Pages (from-to)304-307
Number of pages4
JournalJournal of Gastrointestinal Surgery
Volume12
Issue number2
DOIs
Publication statusPublished - Jan 1 2008

Keywords

  • Gastroesophageal reflux disease
  • Hypertensive lower esophageal sphincter
  • Laparoscopic nissen fundoplication

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

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