Barrett’s oesophagus and nissen fundoplication. The significance of postoperative oesophageal pH measurement

Abstract

Aim — Background

Barrett’s oesophagus is a condition caused by acid reflux from the stomach to the oesophagus for a prolonged period of time. Patients with Barrett’s oesophagus are at significant risk of developing oesophageal adenocarcinoma. This risk decreases with antireflux surgery. Treatment of gastroesophageal reflux disease (GERD) by Nissen fundoplication surgery has a success rate of 85–90%. The aim of this study is to highlight the significance of oesophageal pH measurement as part of the postoperative follow-up of patients diagnosed with Barrett’s oesophagus who undergo the Nissen fundoplication procedure.

Patients and methods

Between 2010 and 2012, eleven patients with Barrett’s oesophagus underwent Nissen fundoplication in our clinic, followed by 48h wireless oesophageal pH-metry monitoring.

Results

All patients reported relief of GERD typical symptoms. Mean DeMeester score of 1.5 was measured at the fifth postoperative month.

Conclusion

Prevention of oesophageal adenocarcinoma in patients with Barrett’s oesophagus is crucial. These patients are exposed to a great risk of adenocarcinoma development, not only owing to the potential progression of Barrett’s oesophagus to adenocarcinoma, but also because of the decreased capacity to experience typical GERD symptoms. Given the possibility of antireflux surgery failure and the fact that symptoms may be an unreliable indicator of GERD presence, postoperative oesophageal pHmetry is mandatory.