Mechanisms of acid, weakly acidic and gas reflux after anti-reflux surgery

Fundoplication reduces oesophageal acid exposure and reflux symptoms in patients with gastroesophageal reflux disease (GORD). The mechanisms behind this are incompletely understood and the effects on non-acid and gas reflux have not been fully evaluated. In this study, 14 patients with GORD were investigated before and three months after fundoplication. The patients underwent impedance pH monitoring to assess the reflux pattern and high-resolution manometry to evaluate the morphology of the oesophagogastric junction and the occurrence of transient lower oesophageal sphincter relaxations (TLOSRs), the main mechanism behind gastroesophageal reflux. Fundoplication was found to greatly reduce both acid and weakly acidic reflux, whereas gas reflux was reduced to a lesser extent. Abolition of the double high-pressure zone profile at the oesophagogastric junction (hiatal hernia), a reduced incidence of TLOSRs and a decreased percentage of TLOSRs associated with reflux were found to be important mechanisms involved in the reduction of reflux events after fundoplication. Unfortunately, no clear mechanisms explaining persistent symptoms or development of gas–bloat symptoms after fundoplication were detected.

See pages 10.1136/gut.2007.133298

Endoscopic trimodal imaging for detection of early neoplasia in barrett’s oesophagus

Endoscopic surveillance of patients with Barrett’s oesophagus is recommended to detect neoplastic lesions at an early and curable stage. However, early neoplastic lesions (high-grade intraepithelial neoplasia or early cancer) are difficult to detect with standard endoscopic techniques and may be missed …