Properly conducted fundoplication reverses histologic evidence of esophagitis.

Little is known about the fate of histologic changes of esophagitis following an antireflux procedure. In a widely quoted paper (Gastroenterology 1979; 76:1393), initial healing of esophagitis was reported, but it was noted that normal biopsies reversed to abnormal in a small number of patients who were followed for up to 69 months. The authors studied esophageal histology in 21 patients undergoing a Nissen fundoplication by a standardized technique. All patients underwent biopsy after operation from 5 to 96 months (mean, 39 months). Nineteen of 21 patients had esophagitis typified by leukocytic infiltration shown on preoperative biopsy. Only two patients had these changes after operation, and one subsequently returned to normal. No patient had evidence of worsening of his esophageal mucosa over time, but several persisted with epithelial changes that included basal cell hyperplasia and papillary elevation. The authors conclude that the Nissen fundoplication, when performed by a standardized technique, leads to reversal of histologic evidence of esophagitis, even for follow-up periods of 96 months, and that the symptomatic status of a patient correlates well with the histologic level of esophagitis.