Original Article

Combined multichannel intraluminal impedance–pH monitoring to select patients with persistent gastro-oesophageal reflux for laparoscopic Nissen fundoplication

  1. I. Mainie1,
  2. R. Tutuian1,
  3. A. Agrawal1,
  4. D. Adams2,
  5. D. O. Castell1,*

Article first published online: 19 OCT 2006

DOI: 10.1002/bjs.5493

Issue

British Journal of Surgery

British Journal of Surgery

Volume 93, Issue 12, pages 1483–1487, December 2006

Additional Information

How to Cite

Mainie, I., Tutuian, R., Agrawal, A., Adams, D. and Castell, D. O. (2006), Combined multichannel intraluminal impedance–pH monitoring to select patients with persistent gastro-oesophageal reflux for laparoscopic Nissen fundoplication. Br J Surg, 93: 1483–1487. doi: 10.1002/bjs.5493

Author Information

  1. 1

    Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, USA

  2. 2

    Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA

*Medical University of South Carolina, 96 Jonathan Lucas Street, 210 Clinical Science Building, PO Box 250327, Charleston, South Carolina 29425, USA

Publication History

  1. Issue published online: 17 NOV 2006
  2. Article first published online: 19 OCT 2006
  3. Manuscript Accepted: 3 OCT 2006

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Abstract

Background:

Combined multichannel intraluminal impedance-pH (MII-pH) monitoring detects gastro-oesophageal reflux and identifies acid and non-acid reflux events. It can be used in patients with persistent symptoms on proton-pump inhibitor (PPI) therapy. The aim of this study was to assess laparoscopic Nissen fundoplication as a treatment for patients with persistent symptoms associated with reflux despite acid suppression documented by MII-pH monitoring.

Method:

A prospectively maintained database identified patients with persistent symptoms of gastro-oesophageal reflux disease despite PPI therapy who had undergone MII-pH monitoring and this was cross-referenced with patients who had undergone fundoplication at this institution. Follow-up after fundoplication was by periodic telephone interview and review of clinical records.

Results:

Of 200 evaluated patients, 19 (14 female; mean age 40 (range 0.7–78) years) underwent laparoscopic Nissen fundoplication. Before surgery, 18 of 19 patients had a positive symptom index (at least half of symptoms associated with reflux) and one, a negative symptom index. After a mean follow-up of 14 (range 7–25) months, 16 of 17 (94 per cent) patients with a positive symptom index were asymptomatic or markedly improved (one patient was lost to follow-up). Persistent symptoms occurred in the patient with a negative symptom index, and one patient had recurrent symptoms after 9 months.

Conclusion:

Patients with a positive symptom index resistant to PPIs with non-acid or acid reflux demonstrated by MII-pH monitoring can be treated successfully by laparoscopic Nissen fundoplication. Copyright © 2006 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

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