Is there an association between failed antireflux procedures and delayed gastric emptying?

Recurrence of gastroesophageal reflux symptoms following antireflux surgery is a difficult clinical problem. Sixteen patients (6 men, 10 women; median age 59; range 33-75 years) with a positive endoscopy or pH-probe-assessed acid reflux and recurrence of reflux symptoms following a fundoplication underwent radionuclide solid and liquid gastric emptying studies. The median time between operation and gastric emptying study was 39 months (range 13-89 months). A control group of 21 patients (10 men, 11 women; median age 47; range 19-72 years) who had undergone a standard fundoplication was similarly studied 6 months following surgery. The per cent of solid remaining at 100 minutes in the stomach had a median value of 43% (range 5-89) in the control group. This was significantly less (p less than 0.0001) than in the failed operative group (median 66%, range 27-100). Similarly, the time taken for 50% of the liquid to leave the stomach had a median value of 13 minutes (range 8-27) in the control group; a value significantly less (p less than 0.01) than the failed operative group (median 18.5 min, range 2-60). It is not known whether the delayed emptying in the failed operative group is responsible for the failure of the antireflux surgery. However, delay in gastric emptying either before or after surgery may be of value in predicting patients likely to have poor outcomes.