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News

Laparoscopic Nissen fundoplication versus PPI for GERD

Research in the most recent BJS finds laparoscopic Nissen fundoplication leads to less acid exposure of the lower esophagus at 3 months, and greater improvements in gastrointestinal and general well-being after 12 months compared with PPI treatment.

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Both laparoscopic Nissen fundoplication and proton-pump inhibitor (PPI) therapy are established in the treatment of gastro-oesophageal reflux disease (GERD).

Dr Mahon and colleagues compared these two treatments in a randomized clinical trial between 1997 and 2001.

The researchers investigated 340 patients with a history of GERD for at least 6 months by endoscopy, 24-hour pH monitoring and manometry.

The mean general well-being scores improved from 95 to106 at 12 months after laparoscopic Nissen fundoplication
British Journal of Surgery

The research team reported that only 217 patients were randomized, with 109 to laparoscopic Nissen fundoplication and 108 to PPI therapy.

The team noted that the 2 groups were well matched for age, sex, weight and severity of reflux.

The investigative team performed 24-hour pH monitoring and manometry 3 months after treatment.

The researchers assessed quality of life in both groups using the Psychological General Well-being Index and the Gastrointestinal Symptom Rating Scale at 3 and 12 months after treatment.

The team found that at 3 months there was an improvement in lower esophageal sphincter pressure from 6 to 17 mmHg in the laparoscopic Nissen fundoplication group.

There was no change in the in lower esophageal sphincter pressure in the PPI group with 8 mmHg before and after treatment.

The researchers observed that the mean DeMeester acid exposure score improved from 43 to 9 in the laparoscopic Nissen fundoplication group and from 37 to18 in the PPI group.

The mean gastrointestinal symptom and general well-being scores improved from 32 and 95 respectively before treatment to 37 and 106 at 12 months after laparoscopic Nissen fundoplication.

The researchers found that the mean gastrointestinal symptom and general well-being scores in the PPI group was 34 and 99 before treatment, and 35 and 100 at 12 months, respectively.

In addition, the team noted that the differences in both of these scores were significant between the 2 groups at 12 months.

Dr concluded, “Laparoscopic Nissen fundoplication leads to significantly less acid exposure of the lower esophagus at 3 months and significantly greater improvements in both gastrointestinal and general well-being after 12 months compared with PPI treatment.”

BJS 2005: 92(6): 695-99
25 May 2005

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