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Am J Physiol Gastrointest Liver Physiol 275: G1386-G1393, 1998;
0193-1857/98 $5.00
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Vol. 275, Issue 6, G1386-G1393, December 1998

Impact of fundoplication on bolus transit across esophagogastric junction

Peter J. Kahrilas1, Shezhang Lin1, Anita E. Spiess1, James G. Brasseur2, Raymond J. Joehl3, and Michael Manka1

1 Division of Gastroenterology and Hepatology, Department of Medicine, and 3 Department of Surgery, Northwestern University Medical School, Chicago, Illinois 60611-3053; and 2 Department of Mechanical Engineering, Pennsylvania State University, University Park, Pennsylvania 16802-1413

This study analyzed the effect of fundoplication on the mechanics of liquid and solid bolus transit across the esophagogastric junction (EGJ). The squamocolumnar junction was endoscopically clipped in seven controls, seven hiatal hernia patients, and seven patients after laparoscopic Nissen fundoplication. Concurrent manometry and fluoroscopy were done during swallows of liquid barium and a 13-mm-diameter marshmallow. The EGJ opening, pressure gradients, transit efficacy, and axial motion were measured. The axial motion of the EGJ was reduced in the fundoplication and hiatal hernia patients. The opening dimensions at the squamocolumnar junction were similar among groups, but in each case the constriction limiting flow to the stomach was at the hiatus and this was substantially narrowed with fundoplication. As a result, liquid intrabolus pressure was increased and marshmallow transit frequently required multiple swallows. We conclude that fundoplication limits the axial mobility of the EGJ and leads to a restricted hiatal opening. These alterations decrease the efficacy of solid and liquid transit into the stomach and are potential causes of dysphagia in this population.

hiatal hernia; lower esophageal sphincter; reflux disease; dysphagia


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