Abstract
Background
Laparoscopic fundoplication cures heart-burn and regurgitation in patients with gastroesophageal reflux disease (GERD) but its effect on the chest pain that is also experienced by some patients is less clear. Confusion stems from the fact that it is difficult to determine preoperatively whether the chest pain is actually caused by the reflux. Therefore, we designed a study in patients with GERD and chest pain that would assess the value of pH monitoring in establishing a correlation between the symptom and the disease, the predictive value of pH monitoring on the results of surgical treatment, and the outcome of laparoscopic fundoplication on chest pain in patients with GERD.
Methods
Of 487 patients who underwent laparoscopic fundoplication for GERD at our institution between October 1992 and July 2000, 165 (34%) complained of chest pain in addition to heartburn and regurgitation. Their symptoms had been present for an average of 118 months. The pH monitoring tracings were analyzed for a correlation between episodes of reflux and chest pain. The mean length of follow-up was 13 months.
Results
Among the 165 patients with chest pain, the relationship between pain and reflux during pH monitoring was as follows: 39 patients (group A) experienced no chest pain during the study; in 28 patients (group B), chest pain correlated with reflux in ≥40% of instances; in 98 patients (group C), chest pain correlated with reflux in ≥40% of instances. Chest pain improved post-operatively in 65% of group A patients, 79% of group B patients, and 96% of group C patients (group C vs A and B: p<0.05). Heartburn and regurgitation resolved or improved in 97% and 95% of patients, respectively.
Conclusions
These data show that pH monitoring helped to identify a relationship between chest pain and reflux; and when the two coincided, the chest pain was relieved by antireflux surgery.
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References
Achem SR, Kolts BE, MacMath T, Richter J, Mohr D, Burton L, Castell DO (1997) Effects of omeprazole versus placebo in treatment of noncardiac chest pain and gastroesophageal reflux. Dig Dis Sci 42: 2138–2145
Achem SR, Kolts BE, Wears R, Burton L, Richter JE (1993) Chest pain associated with nutcracker esophagus: a preliminary study of the role of gastroesophageal reflux. Am J Gastroenterol 88: 187–192
Bancewicz HO, Marples M (1987) Clinical implications of abnormal oesophageal motility. Br J Surg 74: 416–419.
DeCaestecker JS, Blackwell JN, Brown J, Heading RC (1985) The oesophagus as a cause of recurrent chest pain: which patients should be investigated and which test should be used? Lancet 2: 1143–1148
DeMeester TR, O’Sullivan GC, Bermudez; G, Midell AI, Cimochowski GE, O’Drobinak J (1982) Esophageal function in patients with angina-type chest pain and normal coronary angiograms. Ann Surg 196: 488–498
Eubanks TR, Omelanczuk P, Richards C, Pohl D, Pellegrini CA (2000) Outcomes of laparoscopic antireflux procedures. Am J Surg 179: 391–395
Fulp SR, Richter JE (1989) Esophageal chest pain. Am Fam Physician 40: 101–116
Hewson EG, Sinclair JW, Dalton CB, Richter JE (1991) Twentyfour-hour esophageal pH monitoring: the most useful test for evaluating noncardiac chest pain. Am J Med 90: 576–583
Janssens J, Vantrappen G, Ghillebert G (1986) 24-hour recording of esophageal pressure and pH in patients with noncardiac chest pain. Gasteroenterology 90: 1978–1984
Johnson WE, Hagen JA, DeMeester TR, Kauer WKH, Ritter MP, Peters JH, Bremner CG (1996) Outcome of respiratory symptoms after antireflux surgery on patients with gastroesophageal reflux disease. Arch Surg 131: 489–492
Katz PO, Castell DO (2000) Approach to the patient with unexplained chest pain. Am J Gastroenterol 95: S5-S8.
Lam HG, Dekker W, Kan G, Breedijk K, Smout AJ (1992) Acute noncardiac chest pain in a coronary care unit: evaluation by 24-hour pressure and pH recording of the esophagus. Gastroenterology 102: 453–460
Patti MG, Arcerito M, Feo CV, De Pinto M, Tong J, Gantert W, Tyrrell D, Way LW (1998) An analysis of operations for gastroesophageal reflux disease. Arch Surg 133: 600–607
Patti MG, Arcerito M, Tamburini A, Diener U, Feo CV, Safadi B, Fisichella P, Way LW (1999) Effect of laparoscopic fundoplication on gastroesophageal reflux disease-induced respiratory symptoms. J Gastrointest Surg 2000: 143–149
Patti MG, Diener U, Tamburini A, Molena D, Way LW (2001) Role of esophageal function tests in diagnosis of gastoresophageal reflux disease. Dig Dis Sci 46: 597–602
Patti MG, Feo CV, De Pinto M, Arcerito M, Tong J, Gantert W, Tyrrell D, Way LW (1998) Results of laparoscopic antireflux surgery for dysphagia and gastroesophageal reflux disease. Am J Surg 176: 564–568
Peters JH, DeMeester TR, Crookes P, Oberg S, de Vos Shoop M, Hagen JA, Bremner CG (1998) The treatment of gastroesophageal reflux disease with laparoscopic Nissen fundoplication: prospective evaluation of 100 patients with “typical” symptoms. Ann Surg 228: 40–50
Schofield PM, Brooks NH, Colgan S, Bennett DH, Whorwell PJ, Bray CL, Ward C, Jones PE (1987) Left ventricular function and oesophageal function in patients with angina pectoris and normal coronary angiograms. Br Heart J 58: 218–224
Wiener GJ, Richter JE, Copper JB, Wu WC, Castell DO (1988) The symptom index: a clinically important parameter of ambulatory 24-hour esophageal pH monitoring. Am J Gastreonterol 83: 358–361
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Patti, M.G., Molena, D., Fisichella, P.M. et al. Gastroesophageal reflux disease (GERD) and chest pain. Surg Endosc 16, 563–566 (2002). https://doi.org/10.1007/s00464-001-8220-9
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DOI: https://doi.org/10.1007/s00464-001-8220-9