(Dr. Anvari replies)
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* Mehran Anvari

Dr. Kamolz and his colleagues have highlighted some of their recent findings with respect to gas-related symptoms in patients with gastroesophageal reflux disease and the effect of laparoscopic Nissen fundoplication. Of interest is the role of aerophagia, triggered by the presence of refluxate in the esophagus, in causing a sensation of bloating and excessive belching unrelated to meals. The fact that patients with significant aerophagia are found to have more complex disease and manifest more motility disorders supports our theory that heightened sensory signals and central processing of the signals may play a significant role in the sensation of bloating and other gas-related symptoms in patients with gastroesophageal reflux disease (GERD). Their observation supports our study, which found that laparoscopic Nissen fundoplication was an effective antireflux treatment in such patients and that the presence of severe gas-related symptoms in patients with GERD is not a contraindication to surgery.

In response to Dr. Kamolz’s question with respect to any comorbidities that may be associated with worsening of bloating after surgery, unfortunately we did not find any specific comorbidity in these patients. We are currently involved in evaluating a number of specific factors, such as processing of afferent vagal sensory inputs from the stomach and esophagus and the impact of stress, as well as the specific role of aerophagia in the etiology of gas-related symptomatology.