Abstract
Background
Although gastroparesis does not influence gastroesophageal reflux disease (GERD) or antireflux surgery, many patients with GERD will also suffer from gastroparesis-related bloating as a distinct symptom different from GERD-related symptoms. The purpose of this study was to assess whether a pyloroplasty with a fundoplication will improve bloating symptoms in these patients.
Methods
A prospectively gathered database of all patients undergoing antireflux surgery was reviewed. All patients underwent history, physical examination, upper gastrointestinal endoscopy, esophageal manometry, 24-hour esophageal pH monitoring, and, selectively, contrast upper gastrointestinal radiography. Patients with symptoms of bloating also underwent gastric emptying scintigraphy. All patients completed the GERD-Health Related Quality of Life (HRQL) symptom severity questionnaire. One of the items of this instrument relates to bloating. The item is scored from 0 (asymptomatic) to 5 (incapacitating) based on descriptive anchors. Patients with symptomatic GERD and objective findings by physiologic testing were offered antireflux surgery. Those with delayed gastric emptying (defined as T1/2 > 120 minutes) were also offered a pyloroplasty. Operations performed included a laparoscopic or open Nissen or Toupet fundoplication with a Heineke–Mickulicz pyloroplasty. Postoperatively, patients completed the GERD-HRQL and had a gastric emptying scintigraphy performed.
Results
Three-hundred and sixty-nine patients underwent antireflux surgery; of these, 35 patients also had a pyloroplasty. Twenty-eight (80%) of these patients reported significant symptomatic improvement. The median preoperative bloating score improved from 4 to 1 postoperatively (P < 0.05), and the median gastric emptying scintigraphy T1/2 improved from 244 to 112 minutes (P < 0.05).
Conclusions
Although gastroparesis may not contribute to symptoms of GERD, it can contribute to symptoms of bloating. Bloating symptoms improved in 80% of patients with the addition of a pyloroplasty. Therefore, addition of pyloroplasty to a fundoplication in patients with gastroparesis-related bloating can improve bloating symptoms.
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References
Agreus L, Svardsudd K, Talley NJ, et al. Natural history of gastroesophageal reflux disease and functional abdominal disorders: a population based study. Am J Gastroenterol 2001;96:2905–2914
Pimentel M, Rossi F, Chow EJ, et al. Increased prevalence of irritable bowel syndrome in patients with gastroesophageal reflux. J Clin Gastroenterol 2002;34:221–224
Farrell TM, Richardson WS, Halkar R, et al. Nissen fundoplication improves gastric motility in patients with delayed gastric emptying. Surg Endosc 2001;15:271–274
Janiek B, Melvin WS, Eldert B, et al. Impact of delayed gastric emptying on the outcome of antireflux surgery. Ann Surg 2001;234:139–146
Park MI, Camilleri M. Gastroparesis: clinical update. Am J Gastroenterol 2006;101:1129–1139
Frantzides CT, Carlson MA, Zografakis JG, et al. Postoperative gastrointestinal complaints after laparoscopic Nissen fundoplication. JSLS 2006;10:39–42
Velanovich V. Comparison of a disease specific (GERD-HRQL) vs. a generic (SF-36) quality of life instrument. J Gastrointest Surg 1998;2:141–145
Velanovich V. The development of the GERD-HRQL symptom severity instrument. Dis Esophagus 2006, (in press)
Madden G, Jamieson G. Fundoplication enhances gastric emptying. Ann Surg 1985;210:296–299
Velanovich V. Comparison of symptomatic and quality of life outcomes of laparoscopic versus open antireflux surgery. Surgery 1999;126:782–789
Violette A, Velanovich V. Convergence of quality of life scores of laparoscopic and open antireflux surgery. Presented at the 2006 Annual Meeting of the Society for Surgery of the Alimentary Tract. Los Angeles, CA, 2006; 21–24
Horvath KD, Jobe BA, Herron DM, et al. Laparoscopic Toupet fundoplication is an inadequate procedure for patients with severe reflux disease. J Gastrointest Surg 1999;3:583–591
Patti MG, Robinson T, Galvani C, et al. Total fundoplication is superior to partial fundoplication even when esophageal peristalsis is weak. J Am Coll Surg 2004;198:863–869
Oberhelman HA Jr. Vagotomy and pyloroplasty or gastrojejunostomy. In: Nora PF (ed). Operative surgery: principles and techniques 3rd edn. Philadelphia, Saunders, 1990, pp 520–537
DeMeester TR, Bonavina L, Albertucci M. Nissen fundoplication for gastroesophageal reflux disease: evaluation of primary repair in 100 consecutive patients. Ann Surg 1986;204:9–20
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Masqusi, S., Velanovich, V. Pyloroplasty with Fundoplication in the Treatment of Combined Gastroesophageal Reflux Disease and Bloating. World J. Surg. 31, 332–336 (2007). https://doi.org/10.1007/s00268-006-0723-z
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DOI: https://doi.org/10.1007/s00268-006-0723-z