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Dyspeptic Symptoms and Maximal Tolerated Volume during a Water Drinking Test in Post-Nissen Fundoplication Patients

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Remes-Troche, Jose M., M.D.; Montano-Loza, Aldo, M.D.; Martinez-Salgado, Julio, M.D.; Herrera, Miguel F., M.D.; Valdovinos-Diaz, Miguel A., M.D.

American Journal of Gastroenterology: September 2005 - Volume 100 - Issue - p S34–S35
Supplement Abstracts Submitted for the 70th Annual Scientific Meeting of the American College of Gastroenterology: ESOPHAGUS
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Gastroenterolgy, INCMNSZ, Mexico City, Mexico and Surgery, INCMNSZ, Mexico City, Mexico.

Purpose: After Nissen fundoplication (NF), about 30% of patients develop dyspeptic symptoms (DS). NF may cause motor and sensitive disorders in the proximal stomach that could be responsible for DS. The water drinking test (WDT) has demonstrated to discriminate healthy subjects from dyspeptic patients. Our aim was to evaluate the presence of DS and maximal tolerated volume (MTV) with WDT in patients with NF.

Methods: We evaluated 18 post surgical patients with NF by laparoscopic techniques having >6 months after surgery and were compared with 18 healthy volunteers (HV) and 18 functional dyspepsia (FD) patients (Rome II). All subjects answered the Nepean FD questionnaire and underwent WDT at a 15 mL/min ingestion rate. Severity of DS (abdominal pain, distension, early satiety and nausea) was evaluated with a 5 point Likert scale at baseline and every 5 minutes during the WDT. The MTV was considered as the inability to continue drinking water.

Results: There were no gender, age or IMC differences between the 3 groups. Nine (50%) patients with NF developed dyspeptic symptoms after the surgical procedure. The MTV for patients with symptoms after NF was significantly lower than HV and NF patients without symptoms but similar to FD patients (p = 0.001, Figure 1). Symptoms scores for NF patients were significantly higher than HV but similar to FD patients. A significant negative correlation was found between MTV and Nepean index (p = 0.01, Figure 2)

Conclusions: Patients underwent NF who develop FD symptoms, have a lower MTV and higher frequency of symptoms during WDT. These results suggest that NF may diminish gastric accommodation and maybe induce proximal stomach hypersensitivity. [figure 1] [figure 2]

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