Importance of ineffective esophageal motility in patients with erosive reflux disease on the long-term outcome of Nissen fundoplication

Ineffective esophageal motility (IEM) is the most common esophageal motor abnormality among the patients with gastroesophageal reflux disease (GERD). The aim of this study is to establish the impact of IEM on a long-term outcome of Nissen fundoplication (NF). Prospective 5-year follow-up of 124 patients submitted to NF due to erosive GERD from 2002 to 2007. Classification was made according to preoperative manometric findings. Group A consisted of patients with normal esophageal motility, while patients with preoperative manometric criteria for IEM were classified in group B. A regular follow-up protocol included foregut endoscopy, stationary esophageal manometry, and symptomatic questioner on 6 months, 1, 3, and 5 years after surgery. There was no statistical difference between the groups regarding the preoperative dysphagia scores and distribution of reflux esophagitis grade. Nadir esophageal contractions amplitudes showed statistically significant median increase in both groups of patients throughout a 5-year follow-up (p < 0.05). Inside the group B, 77.8 % of patients showed motility recovery. There were no statistical differences regarding the postoperative dysphagia scores between the groups. NF represents the operation of choice for patients with erosive GERD regardless of preoperative manometric findings.