The authors have no funding, financial relationships, or conflicts of interest to disclose.
Traditional reflux parameters and not impedance monitoring predict outcome after fundoplication in extraesophageal reflux†
Article first published online: 16 AUG 2011
Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.
Volume 121, Issue 9, pages 1902–1909, September 2011
How to Cite
Francis, D. O., Goutte, M., Slaughter, J. C., Garrett, C. G., Hagaman, D., Holzman, M. D. and Vaezi, M. F. (2011), Traditional reflux parameters and not impedance monitoring predict outcome after fundoplication in extraesophageal reflux. The Laryngoscope, 121: 1902–1909. doi: 10.1002/lary.21897
- Issue published online: 24 AUG 2011
- Article first published online: 16 AUG 2011
- Manuscript Accepted: 24 MAR 2011
- Manuscript Received: 7 FEB 2011
- Extraesophageal reflux;
- laryngopharyngeal reflux;
- gastroesophageal reflux disease;
- chronic cough;
- Level of Evidence: 2b.
Fundoplication is considered in patients with refractory extraesophageal reflux symptoms. However, postoperative symptom resolution is inconsistent. This analysis investigates which presenting symptoms and preoperative objective parameters predict postoperative symptom improvement.
Retrospective cohort study.
A total of 237 patients referred for extraesophageal reflux symptoms refractory to medical therapy underwent esophageal function testing. Fundoplication was performed in 27 patients with objective evidence of gastroesophageal reflux disease. Symptomatic improvement was assessed at postoperative intervals. Logistic regression determined which symptoms and objective parameters predicted improvement of the presenting extraesophageal reflux symptom.
Overall, 59% of patients reported at least partial improvement of their presenting extraesophageal symptom after fundoplication. Predictors of symptomatic improvement were the presence of heartburn with or without regurgitation concomitant to their primary presenting symptom (odds ratio [OR], 6.6; 95% confidence interval [CI], 0.97-44.9; P = .05) and pH < 4 more than 12% of a 24-hour period (OR, 10.5; 95% CI, 1.36-81.1; P = .02). Probability of postoperative extraesophageal reflux symptom improvement was 90% if both conditions were present.
Both heartburn with or without regurgitation and esophageal pH < 4 more than 12% of a 24-hour period predicted postfundoplication resolution of the presenting extraesophageal reflux symptom.