Abnormal preoperative and postoperative esophageal peristalsis in gastroesophageal reflux

Area of Science:

• Pediatric Gastroenterology
• Gastrointestinal Surgery
• Esophageal Motility Disorders

Background:

• Gastroesophageal reflux (GER) in children can cause esophagitis and symptoms due to impaired antireflux mechanisms.
• Nissen fundoplication is a surgical option for severe, symptomatic GER.
• Understanding the impact of surgery on esophageal function is crucial for managing GER.

Purpose of the Study:

• To evaluate the long-term effects of Nissen fundoplication on esophageal function in children with symptomatic GER.
• To assess the correlation between esophageal peristalsis and clinical outcomes after surgery.
• To investigate the role of different antireflux mechanisms in GER pathogenesis.

Main Methods:

• Prospective study involving 14 children with symptomatic GER and esophagitis.
• Pre- and post-operative (6 months) 24-hour pH monitoring and esophageal manometry.
• Assessment of lower esophageal sphincter pressure (LESP), lower esophageal sphincter length (LESL), and esophageal wave patterns.

Main Results:

• All patients achieved clinical cure of GER with normalized pH monitoring parameters post-surgery.
• Lower esophageal sphincter length (LESL) significantly increased, but LESP remained unchanged.
• Abnormal esophageal peristalsis (tertiary waves) persisted postoperatively, indicating persistent motility issues.

Conclusions:

• Nissen fundoplication effectively corrects GER by creating a competent antireflux barrier, even with impaired esophageal peristalsis.
• Persistent abnormal peristalsis suggests a dual failure of the antireflux mechanism (LES and esophageal pump) in severe GER.
• Surgical restoration of the LES barrier alone can compensate for esophageal motility deficits, leading to clinical improvement.