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 23 May 2018

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News

Efficacy of antireflux surgery in patients with estraesophageal reflux

The most recent issue of the Clinical Gastroenterology & Hepatology examines the association between response to acid-suppression therapy and efficacy of antireflux surgery in patients with extraesophageal reflux.

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The effectiveness of antireflux surgery varies among patients with extraesophageal manifestations of gastroesophageal reflux disease (GERD). 

By studying a cohort of patients with primary extraesophageal symptoms and abnormal physiologic markers for GERD, Dr Michael Vaeziwe and colleagues from Tennessee identified factors associated with positive outcomes from surgery, and compare outcomes to those with typical esophageal manifestations of GERD.

The researchers performed a retrospective cohort study comparing adult patients with extraesophageal and typical reflux symptoms who underwent de novo antireflux surgery from 2004 through 2012 at a tertiary care center. 

All 115 patients had evidence of abnormal distal esophageal acid exposure based on pH testing or endoscopy. 

The team's principle outcome was time to primary symptom recurrence after surgery, based on patient reports of partial or total recurrence of symptoms at follow-up visits. 

Patients were followed up for a median duration of 66 months.

Hiatal hernia size was not associated with symptom response
Clinical Gastroenterology & Hepatology
The team's median time to recurrence of symptoms in the overall cohort was 68 months. 

Symptom recurrence after antireflux surgery was associated with having primarily extraesophageal symptoms, and poor preoperative symptom response to acid-suppression therapy.

The researchers found that patients with primary extraesophageal symptoms who had a full or partial preoperative acid-suppression therapy response experienced lower rates of symptom recurrence compared to patients with poor acid-suppression therapy response. 

The rate of symptom recurrence was lowest among patients with primary typical reflux symptoms who had a partial or full symptom response to acid-suppression therapy. 

The team noted that severity of acid reflux on pH testing, symptom indices, severity of esophagitis, and hiatal hernia size were not associated with symptom response.

Dr Vaeziwe's team concludes, "In a retrospective study, we found the effectiveness of antireflux surgery to be less predictable in patients with extraesophageal symptoms of GERD than in patients with typical GERD."

"Response to acid-suppression therapy before surgery was associated with antireflux surgery effectiveness in patients with extraesophageal reflux symptoms."

"Caution should be exercised when advocating antireflux surgery for patients with extraesophageal symptoms that do not respond to acid-suppression therapy."

Clin Gastroenterol Hepatol 2017: 15(5): 675–681
08 June 2017

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