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Intestinal motility in symptomatic children with fundoplication
C Di Lorenzo1, A Flores, P E Hyman
1Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA 90502.
Insights
Fundoplication did not improve severe gastrointestinal symptoms in children. Preoperative intestinal manometry may identify patients unlikely to benefit from this surgery.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Motility Disorders
Background:
- Fundoplication is a surgical procedure to treat severe gastroesophageal reflux.
- It alters lower esophageal sphincter anatomy but is not expected to affect distal motility.
- Persistent or worsening gastrointestinal symptoms after fundoplication suggest underlying motility issues.
Purpose of the Study:
- To investigate antroduodenal motility in children with persistent symptoms after fundoplication.
- To compare motility patterns between children with and without a history of fundoplication.
- To determine if fundoplication impacts antroduodenal motility or symptom resolution.
Main Methods:
- Antroduodenal manometry was performed on 55 children with upper gastrointestinal motor dysfunction symptoms.
- 28 of these children had previously undergone fundoplication.
- Motility data were compared between the fundoplication group and a control group of unoperated children.
Main Results:
- Abnormal antroduodenal motility was prevalent in both groups (25/28 fundoplication vs. 25/27 controls).
- Fundoplication did not alter the type or severity of motility abnormalities.
- Symptoms remained unchanged or worsened in all children who had fundoplication.
Conclusions:
- Fundoplication failed to alleviate severe functional gastrointestinal symptoms in this cohort.
- Preoperative antroduodenal manometry may be valuable in predicting surgical outcomes.
- Identifying physiological abnormalities preoperatively could guide treatment decisions and avoid ineffective surgeries.
Abstract:
Fundoplication alters the anatomy of the lower esophageal sphincter but should have no direct effects on motility distal to the sphincter. Of 55 children referred for evaluation of symptoms consistent with upper gastrointestinal motor dysfunction, 28 had undergone fundoplication 6 months to 4 years earlier to treat severe gastroesophageal reflux that had failed medical management. All 28 children had symptoms that were unchanged or worsened after fundoplication. In all children, we studied fasting and fed antroduodenal motility, and compared results from groups with and without fundoplication. Abnormalities in antroduodenal motility were found in 25 of 28 of the fundoplication group and in 25 of 27 of unoperated children. We found a wide range of abnormalities, but there were no differences in the types of severity of abnormalities between groups. In summary, in children with severe functional gastrointestinal symptoms, antroduodenal manometry uncovered physiological abnormalities, and fundoplication failed to relieve symptoms. These data suggest that preoperative intestinal manometry could identify children unlikely to benefit from fundoplication.