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Traditional reflux parameters and not impedance monitoring predict outcome after fundoplication in extraesophageal reflux

Authors

  • David O. Francis MD, MS,

    Corresponding author
    1. Vanderbilt Voice Center, Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.
    • Vanderbilt Voice Center, Department of Otolaryngology, Bill Wilkerson Center, Vanderbilt University Medical Center, Medical Center East, South Tower, 1215 21st Avenue South, Suite 7302, Nashville, TN 37232-8783
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  • Marion Goutte BS,

    1. Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.
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  • James C. Slaughter DrPH,

    1. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.
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  • C. Gaelyn Garrett MD,

    1. Vanderbilt Voice Center, Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.
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  • David Hagaman MD,

    1. Allergy, Sinus and Asthma Program, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.
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  • Michael D. Holzman MD, MPH,

    1. Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
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  • Michael F. Vaezi MD, PhD

    1. Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.
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  • The authors have no funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis:

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.

Study Design:

Retrospective cohort study.

Methods:

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.

Results:

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.

Conclusions:

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.

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