The effect of symptoms and nonspecific motility abnormalities on outcomes of surgical therapy for gastroesophageal reflux disease

J Thorac Cardiovasc Surg. 1994 May;107(5):1244-9; discussion 1249-50.


The outcome of Nissen fundoplication in patients with a nonspecific motility abnormality compared with the outcome in patients with normal motility is unknown. One hundred consecutive patients who underwent primary Nissen fundoplication were evaluated before and a median of 50 months after operation, with emphasis on the presence of a preoperative motility disorder and its relationship to preoperative and postoperative symptoms. Compared with patients who had normal motility, patients with a nonspecific motility abnormality had a greater prevalence and severity of heartburn and regurgitation before operation. These patients also had a greater esophageal exposure to gastric juice on pH monitoring as a result of poorer esophageal clearance function. The prevalence and severity of preoperative dysphagia was not related to the presence of a motility disorder. A 90% or a 95% actuarial success rate was achieved in the relief of heartburn and regurgitation over a 96-month period in patients with and without a motility abnormality. The overall actuarial success rate was 93%. Dysphagia was rarely caused or made more severe by the procedure; if present before the operation, it was relieved in most patients. The prevalence of persistent postoperative dysphagia was similar in patients with and without a motility abnormality. The success of Nissen fundoplication in properly selected patients is not affected by the presence of a nonspecific motility disorder.

Publication types

  • Comparative Study

MeSH terms

  • Deglutition Disorders / epidemiology
  • Esophageal Motility Disorders / epidemiology*
  • Esophagus / surgery*
  • Female
  • Follow-Up Studies
  • Gastric Fundus / surgery*
  • Gastroesophageal Reflux / epidemiology
  • Gastroesophageal Reflux / surgery*
  • Heartburn / epidemiology
  • Humans
  • Hydrogen-Ion Concentration
  • Male
  • Middle Aged
  • Monitoring, Physiologic / methods
  • Prevalence
  • Time Factors
  • Treatment Outcome