Function of the proximal stomach after Nissen fundoplication

Background: After Nissen fundoplication patients frequently report upper abdominal (dyspeptic) symptoms. Theoretically, these symptoms may be the result of changes in function of the proximal stomach as induced by fundoplication. Methods: In this case-control study the response of the proximal stomach to both distension by an air-filled bag and a liquid meal were evaluated with the use of a barostat. In 12 patients after fundoplication and 12 healthy volunteers (age- and sex-matched) perception of symptoms was evaluated during both bag distension and liquid meal stimulus. Results: The minimal distending pressure required to overcome the intra- abdominal pressure was significantly different between patients and controls (mean(s.e.m.) 9.34(0.26) versus 6.73(0.43) mmHg; P<0.001). There was no difference between groups in either the fasted state, volume-pressure curve (compliance) or total symptom score. After ingestion of the liquid meal the adaptive relaxation in the fundoplication group was significantly less than that in controls (mean(s.e.m.) 150(29.2) versus 244(34.8) ml; P = 0.04). Conclusion: This study showed that after Nissen fundoplication compliance of the proximal stomach is no different from that in healthy volunteers. Postprandial relaxation of the proximal stomach is decreased and this abnormality may be involved in the pathogenesis of reported dyspeptic symptoms.