Severely impaired gastric accommodation is a hallmark of post‐Nissen functional dyspepsia symptoms. Issue 8 (20th March 2017)

• Record Type: Journal Article
• Authors: Pauwels, A.; Boecxstaens, V.; Broers, C.; Tack, J. F.
• Is Part Of: Neurogastroenterology & motility. Volume 29:Issue 8(2017)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2017-03-20
• Subjects: antireflux surgery -- dyspepsia symptoms -- gastric barostat -- impaired gastric accommodation -- Nissen fundoplication; Gastrointestinal system -- Motility -- Periodicals; Gastrointestinal system -- Innervation -- Periodicals; 616.33
• DOI: 10.1111/nmo.13063
• Languages: English
• ISSNs: 1350-1925

Abstract

Abstract: 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. Abstract : Patients with post‐Nissen dyspepsia show a symptom pattern similar to that in FD patients with postprandial distress syndrome, and the main underlying mechanism seems to be impaired gastric accommodation to a meal.