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Surgical outcome in gastro-esophageal reflux disease patients with inadequate response to proton pump inhibitors

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Abstract

Laparoscopic fundoplication (LF) has been shown to be effective in treatment of patients with gastro-esophageal reflux disease (GERD) requiring long-term medical therapy. Its effectiveness in patients with poor response to proton pump inhibitors (PPIs) has been questioned. We prospectively followed 445 patients with proven GERD inadequately controlled on PPI (up to 120 mg/day) and 274 GERD patients with good response to PPIs (20–120 mg/day) after LF. Patients in both groups underwent 24 h pH testing, esophageal manometry, symptom score evaluation, and quality-of-life (QOL) assessment (SF-36) before and at 6 months, 2 years, and 5 years after surgery. LF was associated with a marked improvement in percentage acid reflux, lower esophageal sphincter pressure, and symptom control in both groups of patients; however, the poor responders to PPIs also had a significant improvement in both physical and mental health component of the QOL assessment. Laparoscopic fundoplication provides an excellent symptom control for GERD patients, even those who have responded inadequately to large doses of PPIs. GERD patients who respond poorly to PPI therapy have significantly lowered physical and mental health QOL scores. Laparoscopic fundoplication in this group of patients leads to marked improvement of both components of QOL by 2 years after surgery.

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References

  1. C Allen M Anvari (1998) ArticleTitleGastroesophageal reflux related cough and its response to laparoscopic fundoplication. Thorax 53 63–68 Occurrence Handle9577525

    PubMed  Google Scholar 

  2. CJ Allen K Parameswaran J Belda M Anvari (2001) ArticleTitleReproducibility, validity and responsiveness of a disease-specific symptom questionnaire for gastroesophageal reflux disease. Dis Esophagus 13 265–270 Occurrence Handle10.1046/j.1442-2050.2000.00129.x

    Article  Google Scholar 

  3. M Anvari CJ Allen (1998) ArticleTitleLaparoscopic Nissen fundoplication: two year comprehensive follow-up of a technique of minimal paraesophageal dissection. Ann Surg 227 25–32 Occurrence Handle10.1097/00000658-199801000-00004 Occurrence Handle1:STN:280:DyaK1c7gsFymsw%3D%3D Occurrence Handle9445106

    Article  CAS  PubMed  Google Scholar 

  4. CM Bate SM Griffin PW Keeling ATR Axon MW Dronfield (1996) ArticleTitleReflux symptom relief in patients without unequivocal oesphagitis. Aliment Pharmacol Ther 10 547–555 Occurrence Handle1:CAS:528:DyaK28Xltlaisbk%3D Occurrence Handle8853758

    CAS  PubMed  Google Scholar 

  5. IT Beck MC Champion S Lemire ABR Thomson (1997) ArticleTitleThe second Canadian consensus conference on the treatment of patients with gastroesophageal reflux disease. Can J Gastroenterol 11 IssueIDsuppl B 7B–20B Occurrence Handle9347173

    PubMed  Google Scholar 

  6. G Champion JE Richter MF Vaesi S Singh R Alexander (1994) ArticleTitleDuodenogastroesophageal reflux: relationship to pH and importance in Barrett’s esophagus. Gastroenterology 107 747–754 Occurrence Handle1:STN:280:ByuA2Mjjslc%3D Occurrence Handle8076761

    CAS  PubMed  Google Scholar 

  7. RYM Chen RJS Thomas (2000) ArticleTitleResults of laparoscopic fundoplication where atypical symptoms coexist with oesophageal reflux. Aust NZ J Surg 70 840–842 Occurrence Handle10.1046/j.1440-1622.2000.01981.x Occurrence Handle1:STN:280:DC%2BD3M%2Fps1Sgtw%3D%3D

    Article  CAS  Google Scholar 

  8. R Carlsson J Dent J Watts S Riley R Sheikh J Hatlebakk K Haug G de Groot A van Oudvorst A Dalvag O Junghard . Wiklund (1998) ArticleTitleGastro-esophageal reflux disease in primary care—An international study of different treatment strategies with omeprazole. Eur J Gastroenterol Hepatol 10 119–124 Occurrence Handle1:STN:280:DyaK1c3ktFWnsA%3D%3D Occurrence Handle9581986

    CAS  PubMed  Google Scholar 

  9. L Grande V Toledo-Pimental C Manterola G Lacima E Ros JC Garcia-Valdecasas J Fuster J Visa C Pera (1994) ArticleTitleValue of Nissen fundoplication in patients with gastroesophageal reflux judged by long-term symptom control. Br J Surg 81 548–550 Occurrence Handle1:STN:280:ByuB28rgsVc%3D Occurrence Handle8205432

    CAS  PubMed  Google Scholar 

  10. DJ Hetzel (1992) ArticleTitleControlled clinical trials of omeprazole in the long-term management of reflux disease. Digestion 1 35–42

    Google Scholar 

  11. EC Klinkenberg-Knol (1993) ArticleTitleThe management of severe, therapy-resistant, reflux oesophagitis. Gullet 3 70–75

    Google Scholar 

  12. L Lundell L Backman P Ekstrom LK Enader S Falkmer O Fausa L Grimelius N Havu T Lind H Lonroth S Sandmark B Sandzen P Unge IH Westin (1991) ArticleTitlePrevention of relapse of reflux esophagitis after endoscopic healing: the efficacy and safety of omeprazole compared to ranitidine. Scand J Gastroenterol 26 248–256 Occurrence Handle1:STN:280:By6A3cros1M%3D Occurrence Handle1853146

    CAS  PubMed  Google Scholar 

  13. L Lundell P Miettinen HE Myrvold SA Pedersen B Liedman JG Hatlebakk R Julkonen K Levander J Carlsson M Lamm I Wiklund (2001) ArticleTitleContinued (5-year) followup of a randomized clinical study comparing antireflux surgery and omeprazole in gastroesophageal reflux disease. J Am Coll Surg 192 172–181 Occurrence Handle10.1016/S1072-7515(00)00797-3 Occurrence Handle1:STN:280:DC%2BD3M7ktlSnsw%3D%3D Occurrence Handle11220717

    Article  CAS  PubMed  Google Scholar 

  14. B O’Brien R Goeree R Hunt J Wilkinson M Levine A Willan (1996) Cost-effectiveness of alternative therapies for the long-term management of gastroesophageal reflux disease. Canadian Coordinating Office for Health Technology Assessment Ottawa

    Google Scholar 

  15. DA Revicki M Wood PN Maton S Sorensen (1998) ArticleTitleThe impact of gastroesophageal reflux disease on health-related quality of life. Am J Med 104 252–258 Occurrence Handle10.1016/S0002-9343(97)00354-9 Occurrence Handle1:STN:280:DyaK1c3htFyitw%3D%3D Occurrence Handle9552088

    Article  CAS  PubMed  Google Scholar 

  16. M Ruth I Manson N Sandberg (1991) ArticleTitleThe prevalence of symptoms suggestive of esophageal disorders. Scand J Gastroenterol 26 73–81 Occurrence Handle1:STN:280:By6C2szisVU%3D Occurrence Handle2006401

    CAS  PubMed  Google Scholar 

  17. JE Ware M Kosinski D Keller (1994) SF-36 Physical and Mental Health Summary Scales: a user’s manual, 3rd printing, revised. The Health Institute, New England Medical Center Boston, MA

    Google Scholar 

  18. JE Ware M Kosinski D Keller (1994) SF-36 Physical and Mental Health Summary Scales: A User’s Manual. 3rd printing, revised. The Health Institute, New England Medical Center Boston, MA 7: 23

    Google Scholar 

  19. JE Ware M Kosinski D Keller (1994) SF-36 Physical and Mental Health Summary Scales: A User’s Manual, 3rd printing, revised. The Health Institute, New England Medical Center Boston, MA 7: 26

    Google Scholar 

  20. JE Ware M Kosinski D Keller (1994) SF-36 Physical and Mental Health Summary Scales: A User’s Manual, 3rd printing, revised. The Health Institute, New England Medical Center Boston, MA 8: 15

    Google Scholar 

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Acknowledgements

The authors thank Ms. Leslie DiLuca and Ms. Lynda Baker for their assistance in data collection, and Ms. Catherine Gill Pottruff for her assistance with preparation of the manuscript. This research was supported by a grant for the Ontario Ministry of Health and Long-Term Care.

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  1. Departments of Surgery and Medicine, St. Joseph’s Hospital, McMaster University, Hamilton, Canada

    M. Anvari & C. Allen

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  1. M. Anvari
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  2. C. Allen
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Anvari, M., Allen, C. Surgical outcome in gastro-esophageal reflux disease patients with inadequate response to proton pump inhibitors . Surg Endosc 17, 1029–1035 (2003). https://doi.org/10.1007/s00464-002-8571-x

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