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Related Experiment Video

Updated: Apr 14, 2026

Robotic Myotomy and Partial Fundoplication for Achalasia
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Esophageal hypermotility: cause or effect?

O M Crespin1, R P Tatum1, R B Yates1

  • 1University of Washington, Surgery, Seattle, WA, USA.

Diseases of the Esophagus : Official Journal of the International Society for Diseases of the Esophagus
|April 21, 2015
PubMed
Summary
This summary is machine-generated.

Laparoscopic Nissen fundoplication (LNF) effectively treated symptoms in patients with esophageal hypermotility disorders and acid reflux. Post-surgery, patients experienced symptom resolution or improvement, suggesting acid exposure, not motility, causes symptoms.

Keywords:
distal esophageal spasmesophageal spastic motility disordersgastroesophageal reflux diseasehypertensive lower esophageal sphincterlaparoscopic Nissen fundoplicationnutcracker esophagus

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Area of Science:

  • Gastroenterology
  • Esophageal Physiology
  • Surgical Interventions

Background:

  • Esophageal motility disorders like Nutcracker esophagus (NE), Jackhammer esophagus (JHE), distal esophageal spasm (DES), and hypertensive lower esophageal sphincter (HTLES) can coexist with gastroesophageal reflux.
  • The primary cause of symptoms in patients with both conditions is often unclear, leading to diagnostic and therapeutic challenges.
  • Laparoscopic Nissen fundoplication (LNF) is a surgical option for gastroesophageal reflux disease (GERD), but its effect on concurrent esophageal motility disorders is less understood.

Purpose of the Study:

  • To evaluate the effectiveness of laparoscopic Nissen fundoplication (LNF) in managing patients with esophageal hypermotility disorders and abnormal gastroesophageal reflux.
  • To assess the impact of LNF on esophageal motility parameters, acid exposure, and symptom severity in affected patients.
  • To differentiate the contribution of acid reflux versus motility disorders to patient symptomatology.

Main Methods:

  • Retrospective review of 221 patients diagnosed with spastic esophageal motility disorders via high-resolution manometry (2007-2013).
  • Analysis of patient symptoms (heartburn, regurgitation, respiratory, dysphagia, chest pain), 24-hour pH monitoring results, and manometry findings.
  • Comparison of pre- and postoperative data for 38 patients who underwent LNF and had at least 6-month follow-up, including clinical evaluation, manometry, and pH monitoring.

Main Results:

  • Of 221 patients, 103 had abnormal distal esophageal acid exposure; 66 underwent LNF, and 38 had adequate follow-up.
  • Post-LNF, all 38 patients normalized esophageal acid exposure. Symptoms resolved in 28 (73.7%) and improved in 10 (26.3%).
  • Postoperative manometry in six patients showed normalized motility in five, suggesting LNF may improve motility parameters.

Conclusions:

  • Laparoscopic Nissen fundoplication is effective in resolving or improving symptoms in patients with esophageal hypermotility disorders and abnormal acid exposure.
  • The findings suggest that abnormal acid exposure, rather than the motility disorder itself, is the primary driver of symptoms in this patient population.
  • LNF may also lead to improvements in esophageal motility parameters, warranting further investigation.