Effects of anti-reflux surgery on weakly acidic reflux and belching

BackgroundLaparoscopic Nissen fundoplication (LNF) is the most frequently performed operation for gastro-oesophageal reflux disease (GORD). However, 12% of the patients 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 belching was evaluated.MethodsIn 31 patients upper gastrointestinal endoscopy, stationary oesophageal manometry and 24-h impedance–pH monitoring off acid secretion inhibiting drugs was performed before and 6 months after primary LNF for GORD that was refractory to proton pump inhibitors. Patients filled out validated questionnaires on GERD-HRQoL before and 3, 6 and 12 months after surgery.ResultsLNF 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