The relationship between symptom severity and objective evidence of gastro-esophageal reflux disease (GERD) after medical and surgical treatment, has recently been questioned.
A study designed by Dr Jenkinson and colleagues aimed to compare the symptomatic and physiological response (as measured by pHmetry) to the treatment of GERD with proton pump inhibitors (PPIs) and laparoscopic antireflux surgery.
The research team also examined the relationship between the patient's subjective and objective response to treatment of GERD.
The investigators included 70 patients in the study, who all underwent 24-h esophageal pH measurement and DeMeester symptom assessment (for heartburn and regurgitation, grade 0-3) while off medical treatment, while taking PPIs and after laparoscopic fundoplication.
|Out of 19 patients who remained symptomatic after surgery only 2 had pathological acid reflux|
|British Journal of Surgery|
The researchers found that the median percentage total time with esophageal pH < 4 off treatment, during medical treatment and after fundoplication was 9•5, 4•3 and 0•5 per cent respectively.
The research group noted that after medical treatment, 30 patients became asymptomatic although 18 of these still had pathological reflux on pH testing.
Of the 19 patients who remained symptomatic after surgery only 2 had pathological acid reflux.
Dr Jenkinson concluded, "The symptomatic response of patients to either PPIs or antireflux surgery is a poor indicator of successful treatment in terms of reduced lower esophageal acid exposure."
"A high proportion of patients whose symptoms are improved by PPIs still have pathological levels of acid reflux."
"Conversely, most patients who complain of reflux symptoms after antireflux surgery have no evidence of residual reflux on pHmetry."