[Reflux esophagitis. What factors influence the choice of antireflux surgery?]

The surgical goal of gastroesophageal reflux treatment is to restore the ability of antireflux barrier. The basal tone and the length of lower esophageal sphincter are commonly considered the most important factors in the assessment of gastroesophageal reflux symptoms. However, reflux symptoms may also occur after surgical correction of sphincter incompetence. In the present study, 20 patients were evaluated pre- and postoperatively by 24 hours pH monitoring, esophageal manometry, endoscopy and analysis of gastric emptying of solids, in order to verify surgical results and connected functional changes. Preoperative data suggested to perform a partial fundoplication in 12 patients and a total fundoplication in 8 cases. Our results can indicate that fundoplications are able to significantly control reflux symptoms, to improve the competence of lower esophageal sphincter and finally to normalize gastric emptying of solids. This study emphasizes the value of normalizing a delayed gastric emptying to assure a satisfactory clinical outcome. The postoperative impaired gastric emptying rates in fact appear to associate with persistent symptoms.