Esophageal Hypersensitivity and Nissen Fundoplication

Esophageal Hypersensitivity and Nissen Fundoplication

Angela from Houston sent us this question: “Do you see esophageal hypersensitivity come and go at Houston heartburn and Reflux Center? Does Nissen fundoplication make hypersensitivity goes away? Thank you for your opinion.”

Dear Angela,

I have never performed a Nissen fundoplication for a case of pure esophageal hypersensitivity (no hiatal hernia, no esophageal inflammation and negative esophageal ambulatory pH testing). Nissen fundoplication is primarily indicated for stage 3 and stage 4 acid reflux disease. It reliably stops acid reflux and allow patients to regain their quality of life.

Esophageal hypersensitivity patients report heartburn and chest pain in response to normal and physiologic acid reflux due to a lower threshold for symptom perception and reporting. The anti-reflux barrier is intact in esophageal hypersensitivity cases. Patients with depression, anxiety, somatization disorders and fibromyalgia have a higher prevalence of esophageal hypersensitivity. Therefore, first line treatment relies on stress reduction and pharmacologic neuromodulation.

If this approach fails to alleviate symptoms, Nissen fundoplication may be considered for acid hypersensitivity. Several small studies in the literature support this claim. Indeed, Nissen fundoplication is a supraphysiologic procedure. Patients with esophageal hypersensitivity may benefit from eliminating the few acid reflux episodes that physiologically occur under normal circumstances. Furthermore, Nissen fundoplication reduce distal esophageal wall compliance and limits volume expansion and stretching in this area. This may help reduce symptoms because esophageal balloon distention results in heartburn and pain in patients with acid hypersensitivity.

To summarize, a thorough and proper evaluation of patients with acid reflux related symptoms by an experienced acid reflux specialist in Houston is strongly recommended to choose the best treatment solution and ensure best outcome.