ORIGINAL ARTICLE Can Different Subsets of Ineffective Esophageal Motility Influence the Outcome of Nissen Fundoplication? Aleksandar P. Simić & Ognjan M. Skrobić & Richard R. Gurski & Vladimir M. Šljukić & Nenad R. Ivanović & Predrag M. Peško Received: 10 March 2014 /Accepted: 22 July 2014 /Published online: 5 August 2014 # 2014 The Society for Surgery of the Alimentary Tract Abstract Background Ineffective esophageal motility (IEM) in patients with gastroesophageal reflux disease includes three different subsets that may affect symptom profiles. Our aim was to assess symptoms and functional outcome in patients with erosive esophagitis according to different subsets of IEM, before and after Nissen fundoplication (NF). Methodology A retrospective study with prospective follow-up of 72 patients with reflux esophagitis and IEM in whom open NF was performed. Based on principal manometric esophageal body motility disorder, patients were divided in three groups: predominantly low-amplitude (LAC, N =38), non-propulsive (NPC, N =18), and simultaneous low-amplitude esophageal contractions (SC, N =16). Patients underwent symptomatic questionnaire and stationary esophageal manometry before and 6 months, 1 year, and 3 years after surgery. Results Preoperatively, patients in NPC and SC groups had higher mean scores of dysphagia, without statistical significance as opposed to the LAC group (p =0.239). Postoperative dysphagia occurred in 36 patients, without statistical significance between groups regarding dysphagia grades (p =0.390). A longer duration of postoperative dysphagia was noted in the SC group (p <0.05). Improvement of nadir values of contraction amplitudes in distal esophagus occurred postoperatively in all groups, significantly higher in LAC (p <0.001). Conclusion Three years after NF, successful symptomatic and functional outcome was achieved in analyzed groups of patients with erosive esophagitis regardless of IEM subtype. Keywords Ineffective esophageal motility . Nissen fundoplication . Gastroesophageal reflux disease Introduction The universal feature for nearly all episodes of gastroesopha- geal reflux (GER) is loss of the normal gastroesophageal antireflux barrier and its resistance to the retrograde flow of gastric juice into the esophagus. 1 One of the three mainstays of the antireflux barrier is the effective clearance of refluxed gastric contents from the esophagus that is dependent primar- ily on adequate esophageal peristalsis. Unfortunately, most of the patients with gastroesophageal reflux disease (GERD) are suffering from esophageal body motor disorders. 2 Various impairment types of esophageal body motility can occur in patients with GERD, but the majority of them can be classified as ineffective esophageal motility (IEM). As defined by Spechler and Castell, IEM includes three rather distinct patterns with the same outcome, meaning that they can result in ineffective esophageal clearance: low-peristaltic-wave-am- plitude contractions (LACs) in the distal esophagus, non- propulsive esophageal contractions (NPCs), and the presence of low-amplitude simultaneous contractions (SCs). 3 It has been reported that different subsets of GERD patients with IEM can have diverse symptom profiles, meaning that patients with low-amplitude contractions will have higher incidence A. P. Simić (*) : O. M. Skrobić : V. M. Šljukić : N. R. Ivanović : P. M. Peško Department of Esophagogastric Surgery, First Surgical University Hospital, Clinical Center of Serbia, Koste Todorovica St 6, 11.000 Belgrade, Serbia e-mail: apsimic@med.bg.ac.rs R. R. Gurski Department of General and Digestive Surgery, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil A. P. Simić : P. M. Peško School of Medicine, University of Belgrade, Belgrade, Serbia J Gastrointest Surg (2014) 18:1723–1729 DOI 10.1007/s11605-014-2607-0