Hasak et al identified factors associated with postfundoplication dysphagia. These can help to identify a patient who may benefit from additional therapy. The authors are from Washington University in Saint Louis.
Patient selection: fundoplication for reflux (antireflux surgery)
Dysphagia was considered clinically significant if it was rated 2 or higher on a Likert scale ranging from 0 to 4.
Classification of postfundoplication dysphagia:
(1) early-onset: <= 6 weeks after surgery
(2) late-onset: > 6 weeks
Early-onset dysphagia usually responds to conservative therapy.
Significant late-onset dysphagia often responds to endoscopic dilation.
Predictors for late-onset dysphagia on univariate analysis:
(1) dysphagia prior to fundoplication
(2) early-onset postfundoplication dysphagia (??)
(3) recurrent hiatal hernia
(4) lack of contraction reserve following multiple rapid swallows (five 2 mL swallows less than 4 seconds apart)
Absence of contraction reserve was defined as a ratio < 1 for (the mean distal contractile integral during multiple rapid swallows) divided by (the distal contractile integral for s single swallow).
Lack of contraction reserve was the independent predictor on multivariate analysis with odds ratio 3.7.
