Laparoscopic fundoplication cures heartburn and regurgitation in patients with gastroesophageal reflux disease (GERD).
However, it is unclear what effect this procedure can have on the chest pain that is also experienced by some patients, as it is difficult to determine preoperatively whether the chest pain is also caused by the reflux.
In order to try and overcome this problem, a new study from a group based in the Department of Surgery at the University of California-San Francisco (UCSF), USA, has assessed the value of pH monitoring in establishing a correlation between the symptom (chest pain) and the disease (GERD).
In addition, the study was designed to determine 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.
Between October 1992 and July 2000 the research group questioned 487 patients who underwent laparoscopic fundoplication for GERD at UCSF.
|Laparoscopic fundoplication - cured heartburn in 97% of cases
A total of 165 patients (34%) complained of chest pain in addition to heartburn and regurgitation, with their symptoms having been present for an average of 118 months.
The pH monitoring tracings for these subjects were then analyzed for a correlation between episodes of reflux and chest pain. The mean length of follow-up was 13 months.
Of the 165 patients, 39 patients (Group A) experienced no chest pain during the study.
In 28 patients (Group B), chest pain correlated with reflux in less than 40% of instances, while in a further 98 patients (Group C) reflux and chest pain were experienced at the same time in over 40% of instances.
Chest pain improved postoperatively in 65% of Group A patients, 79% of Group B patients, and 96% of Group C patients.
Heartburn and regurgitation resolved or improved in 97% and 95% of patients, respectively.
Speaking on behalf of his co-authors, M.G. Patti commented, "These data show that pH monitoring can help to identify a relationship between chest pain and reflux; and when the two coincided, the chest pain can be relieved by antireflux surgery."