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Severely impaired gastric accommodation is a hallmark of post‐Nissen functional dyspepsia symptoms
Author(s) -
Pauwels A.,
Boecxstaens V.,
Broers C.,
Tack J. F.
Publication year - 2017
Publication title -
neurogastroenterology and motility
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.489
H-Index - 105
eISSN - 1365-2982
pISSN - 1350-1925
DOI - 10.1111/nmo.13063
Subject(s) - nissen fundoplication , accommodation , medicine , high resolution manometry , gastroenterology , psychology , neuroscience , disease , reflux
Background Laparoscopic Nissen fundoplication is a commonly performed antireflux surgery, after which reflux symptoms are well controlled, however, complications such as inability to belch or dyspeptic symptoms (mimicking those of functional dyspepsia [ FD ]) might occur. The aim of the study was to prospectively evaluate symptom pattern and underlying pathophysiological mechanisms in patients with post‐Nissen dyspepsia. Methods Twenty‐four patients (12 f, mean age 44.5±2.8 years) with post‐Nissen dyspepsia symptoms, five patients (3 f, mean age 38.8±3.2 years) with post‐Nissen dysphagia symptoms and 14 pre‐fundoplication patients (3 f, mean age 42.1±2.5 years) were evaluated. Patients filled out a Rome II‐based dyspepsia symptom severity score, performed a gastric emptying test, and a gastric barostat study was used to evaluate the function of the proximal stomach. Key Results Upper abdominal bloating scores were higher in post‐Nissen dyspepsia patients ( P =.016) and symptoms of postprandial distress syndrome ( PDS ) were more present in post‐Nissen dyspepsia patients compared to the other two groups ( P =.07). Weight loss was significantly higher in the post‐Nissen groups compared to the pre‐fundoplication ( P =.02). Gastric emptying rates were similar in the three groups. Gastric accommodation ( GA ) was significantly impaired in the post‐Nissen dyspepsia group (dyspepsia −30[−86‐83] vs dysphagia 163[148‐203] vs pre‐fundoplication 147[75‐174] mL, P =.004) and the prevalence of patients with impaired GA was higher in the post‐Nissen group ( P =.007). Postprandial fullness was more prevalent in patients with impaired GA compared to those with normal GA ( P =.01). Conclusions and Interferences Patients with post‐Nissen dyspepsia show a symptom pattern similar to that in FD patients with PDS , and the main underlying mechanism seems to be impaired gastric accommodation to a meal.