Presented to the World Congress of the International Society for Diseases of the Esophagus, Budapest, Hungary, September 2008
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Original article
Impact of symptom–reflux association analysis on long-term outcome after Nissen fundoplication†
Article first published online: 19 OCT 2010
DOI: 10.1002/bjs.7296
Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
Additional Information
How to Cite
Broeders, J. A., Draaisma, W. A., Bredenoord, A. J., Smout, A. J., Broeders, I. A. and Gooszen, H. G. (2011), Impact of symptom–reflux association analysis on long-term outcome after Nissen fundoplication. British Journal of Surgery, 98: 247–254. doi: 10.1002/bjs.7296
- †
Publication History
- Issue published online: 22 DEC 2010
- Article first published online: 19 OCT 2010
- Manuscript Accepted: 25 AUG 2010
Funded by
- University Medical Center Utrecht Alexandre Suerman
- Abstract
- Article
- References
- Cited By
Broader indication for surgery
Abstract
Background:
A positive symptom association probability (SAP) is regarded as an important selection criterion for antireflux surgery by many physicians. However, no data corroborate the relationship between symptom–reflux association and outcome, nor is it clear what impact a negative SAP has on the outcome of antireflux surgery in patients with abnormal oesophageal acid exposure. This study compared long-term outcomes of Nissen fundoplication in patients with a negative versus positive SAP.
Methods:
Five-year outcome of Nissen fundoplication in patients with proton-pump inhibitor (PPI)-refractory reflux and pathological acid exposure was compared between those with (SAP+, 109) and without (SAP−, 29 patients) a positive symptom association. Symptoms, quality of life (QoL), PPI use, endoscopic findings, manometry and acid exposure were evaluated.
Results:
At 5 years' follow-up, relief of reflux symptoms (95 versus 87 per cent), reduction in PPI use (80 to 25 per cent versus 85 to 14 per cent; P < 0·050) and improvement in QoL were similar in the SAP− and SAP+ groups. Reduction in acid exposure time (13·4 to 1·6 per cent versus 11·1 to 0·2 per cent of total time; P < 0·010), improvement in oesophagitis (44 to 6 per cent versus 61 to 13 per cent; P < 0·050) and increase in lower oesophageal sphincter pressure were also comparable.
Conclusion:
The subjective and objective outcomes of fundoplication in patients with pathological acid exposure are comparable among those with a positive and negative SAP. Patients with pathological acid exposure and a negative SAP can also benefit from antireflux surgery. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.