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Laparoscopic Partial Fundoplication in Case of Gastroesophageal Reflux Disease Patient with Absent Esophageal Motility.

Seo KW, Park MI, Yoon KY, Park SJ, Kim SE - J Gastric Cancer (2015)

Bottom Line: The surgical indications for the treatment of gastroesophageal reflux disease (GERD) in patients with esophageal motility disorders have been debated.After surgery, his subjective symptoms improved.Furthermore, objective findings including manometry and 24-hour pH-metry also improved.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Kosin University College of Medicine, Busan, Korea.

ABSTRACT
The surgical indications for the treatment of gastroesophageal reflux disease (GERD) in patients with esophageal motility disorders have been debated. We report a case of antireflux surgery performed in a patient with absent esophageal motility as categorized by the Chicago classification (2011). A 54-year-old man underwent laparoscopic Toupet fundoplication due to apparent GERD and desire to discontinue all medications. After surgery, his subjective symptoms improved. Furthermore, objective findings including manometry and 24-hour pH-metry also improved. In our experience, antireflux surgery can improve GERD symptoms patients, even with absent esophageal motility.

No MeSH data available.


Related in: MedlinePlus

Preoperative barium swallow showing retention of contrast flow at the distal esophagus with esophageal dilatation.
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Figure 1: Preoperative barium swallow showing retention of contrast flow at the distal esophagus with esophageal dilatation.

Mentions: A 54-year-old man with a 10-year history of GERD and both typical and atypical symptoms was referred to the surgical clinic for antireflux surgery because of his desire to stop medications. His typical symptoms were epigastric soreness and regurgitation, while atypical symptoms included a globus sensation. He had been successfully treated with PPIs for 10 years. The patient underwent several studies to investigate the cause of his symptoms. A barium swallow study showed retention of contrast flow at the distal esophagus with minimal esophageal dilatation. It also demonstrated decreased peristaltic movement in the entire esophagus (Fig. 1). In addition, esophagogastroduodenoscopy (EGD) revealed that the gastric cardia did not tightly surround a retroflexed endoscope (Fig. 2A). Esophageal high resolution manometry (HRM) showed absent peristalsis of the distal esophagus (Fig. 3) with decreased basal lower esophageal sphincter (LES) pressure (10.5 mmHg) and zero of mean distal contractile integral (DCI). However, integrated relaxation pressure (IRP) was within normal levels of 6.6 mmHg (Table 1). Next, 24-hour impedance pH monitoring showed that all reflux distal episode, symptom index, and the DeMeester score were 79, 50%, and 82.6, respectively. We also observed an all reflux percent time of 5.3% (Table 1). Based on these findings, the final diagnosis according to the 2011 revised Chicago classification criteria was PPI-responsive GERD without dysphagia and absent peristalsis, and with low resting pressure. Therefore, surgeons and gastroenterologists planned a laparoscopic Toupet (posterior 270°) fundoplication to avoid postoperative dysphagia.


Laparoscopic Partial Fundoplication in Case of Gastroesophageal Reflux Disease Patient with Absent Esophageal Motility.

Seo KW, Park MI, Yoon KY, Park SJ, Kim SE - J Gastric Cancer (2015)

Preoperative barium swallow showing retention of contrast flow at the distal esophagus with esophageal dilatation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4496439&req=5

Figure 1: Preoperative barium swallow showing retention of contrast flow at the distal esophagus with esophageal dilatation.
Mentions: A 54-year-old man with a 10-year history of GERD and both typical and atypical symptoms was referred to the surgical clinic for antireflux surgery because of his desire to stop medications. His typical symptoms were epigastric soreness and regurgitation, while atypical symptoms included a globus sensation. He had been successfully treated with PPIs for 10 years. The patient underwent several studies to investigate the cause of his symptoms. A barium swallow study showed retention of contrast flow at the distal esophagus with minimal esophageal dilatation. It also demonstrated decreased peristaltic movement in the entire esophagus (Fig. 1). In addition, esophagogastroduodenoscopy (EGD) revealed that the gastric cardia did not tightly surround a retroflexed endoscope (Fig. 2A). Esophageal high resolution manometry (HRM) showed absent peristalsis of the distal esophagus (Fig. 3) with decreased basal lower esophageal sphincter (LES) pressure (10.5 mmHg) and zero of mean distal contractile integral (DCI). However, integrated relaxation pressure (IRP) was within normal levels of 6.6 mmHg (Table 1). Next, 24-hour impedance pH monitoring showed that all reflux distal episode, symptom index, and the DeMeester score were 79, 50%, and 82.6, respectively. We also observed an all reflux percent time of 5.3% (Table 1). Based on these findings, the final diagnosis according to the 2011 revised Chicago classification criteria was PPI-responsive GERD without dysphagia and absent peristalsis, and with low resting pressure. Therefore, surgeons and gastroenterologists planned a laparoscopic Toupet (posterior 270°) fundoplication to avoid postoperative dysphagia.

Bottom Line: The surgical indications for the treatment of gastroesophageal reflux disease (GERD) in patients with esophageal motility disorders have been debated.After surgery, his subjective symptoms improved.Furthermore, objective findings including manometry and 24-hour pH-metry also improved.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Kosin University College of Medicine, Busan, Korea.

ABSTRACT
The surgical indications for the treatment of gastroesophageal reflux disease (GERD) in patients with esophageal motility disorders have been debated. We report a case of antireflux surgery performed in a patient with absent esophageal motility as categorized by the Chicago classification (2011). A 54-year-old man underwent laparoscopic Toupet fundoplication due to apparent GERD and desire to discontinue all medications. After surgery, his subjective symptoms improved. Furthermore, objective findings including manometry and 24-hour pH-metry also improved. In our experience, antireflux surgery can improve GERD symptoms patients, even with absent esophageal motility.

No MeSH data available.


Related in: MedlinePlus