Effects of anti-reflux surgery on weakly acidic reflux and XXXX .

@entity1 @entity2749 @entity344 @entity6505 @entity354
BACKGROUND: Laparoscopic Nissen fundoplication (LNF) is the most frequently performed operation for @entity354 ( @entity354 ). However, 12% of the @entity1 have persistent reflux symptoms and 19% develop gas-related symptoms after LNF. Weakly acidic reflux and inability to belch have been alleged to cause these symptoms, respectively. The effect of LNF on weakly acidic reflux and (supra) gastric @entity6505 was evaluated. METHODS: In 31 @entity1 upper @entity344 , stationary oesophageal manometry and 24-h impedance-pH monitoring off acid secretion inhibiting drugs was performed before and 6 months after primary LNF for @entity354 that was refractory to proton pump inhibitors. @entity1 filled out validated questionnaires on GERD-HRQoL before and 3, 6 and 12 months after surgery. RESULTS: LNF reduced reflux symptoms (18.6 > 1.6; p = 0.015). The procedure drastically reduced the incidence (number per 24 h) of acid (76.0 > 1.6; p < 0.001) and weakly acidic (13.6 > 5.7; p = 0.001) as well as liquid (53.4 > 5.4; p<0.001) and mixed @entity2749 (36.3 > 1.9; p < 0.001). In contrast, gas reflux was reduced to lesser extent (35.6 > 25.7; p = 0.022). Proximal, mid-oesophageal and distal reflux were reduced to a similar extent. Persistent @entity354 symptoms were neither preceded by acid nor by weakly acidic reflux. The number of air swallows did not change, but the number of gastric belches (GBs) was greatly reduced (68.5 > 23.9; p < 0.001). Twenty-three @entity1 had supragastric belches (SGBs), both before and after surgery, whereas eight @entity1 had no SGBs at all. The majority of SGBs were not reflux associated and the frequency was greatly increased after LNF (20.8 > 46.0; p = 0.036). Reflux-associated SGBs were abolished after surgery (14.0 > 0.4; p < 0.001). CONCLUSIONS: LNF similarly controls acid and weakly acidic reflux, but gas reflux is reduced to lesser extent. Persistent reflux symptoms are neither caused by acid nor by weakly acidic reflux. LNF alters the @entity6505 pattern by reducing GBs (air venting from stomach) and increasing SGBs (no air venting from stomach). This explains the increase in @entity6505 experienced by some @entity1 after LNF, despite the reduction in gastric @entity6505 . It can be hypothesised that the reduction in GBs after LNF incites @entity1 to increase SGBs in a futile attempt to vent air from the stomach.
