Which of the following is a contraindication to anti-reflux surgery?
a) History of a seizures and remote colonic surgery
b) Frequent vomiting
c) Achalasia
d) Helicobacter pylori infection
e) Chronic lung disease with pulmonary hypertension
Answer c. Remote abdominal surgery may increase the likelihood of requiring an open (as opposed to laparoscopic) anti-reflux procedure, but is not a contraindication. Patients with vomiting and/or chronic lung disease often stand to gain the most from this procedure. H. pylori colonization or infection is not routinely assessed; the presence of infection in the gastric mucosa may warrant medical treatment for symptomatic relief prior to invasive surgery, but it is not a contraindication for surgery. Esophageal motility disorders, such as achalasia, are a contraindication for fundoplication because (1) the symptoms may be related to the functional obstruction in the esophagus and not to “reflux” per se, and (2) tightening the lower esophageal sphincter will worsen the motility defect.