Atypical symptoms do not improve to the same extent as typical symptoms after laparoscopic fundoplication in gastroesophageal reflux patients

W. S. Richardson, T. L. Trus, J. W. Wo, G. B. Branum, J. P. Waring, S. Mauren, J. G. Hunter

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Abstract

Atypical reflux symptoms usually require more intensive antireflux treatment than typical symptoms. The results of antirefiux surgery on patients with atypical symptoms have not been well studied in patients with gastroesophageal reflux (GER). 317 patients with GER underwent laparoscopic fundoplication (LF). Symptom severity scores (SSS) (0-none to 4-severe) were obtained preoperatively and six weeks and/or one year postoperatively. Where possible 1 year data were used. Complete data were available in 215 patients. Three groups were defined: Group I was 108 patients (52%) with severe (SSS=3-4) heartburn (HB) and no severe atypical symptoms (cough, hoarseness, chest pain, asthma); Group II was 82 patients (38%) with severe HB and one or more severe atypical symptoms (ASx); Group III was 25 patients (12%) with severe ASx only. The symptomatic response to surgery was compared between groups with the Mann-Whitney U test. Where there were two or more severe ASx, the scores were averaged. HB resolved (SSS=0) in 89% and 79% and improved (SSS=1-2) in 9.2% and 17% of Groups I and II, respectively. ASx resolved in 35% of Groups II and III and improved in 48% of Group II and 44% of Group III. After laparoscopic fundoplication HB scores improved to a greater extent than ASx scores in patients with both types of symptoms (Group II) (p<.01) TABLE 1: SSS before and after LF [mean (SD) Group I Group II Group III HB HB ASx ASx pre-op 3.4 (0.5) 3.5 (0.5) 33 (0.4) 3.4 (0.5) post-op 0.2(0.6) 1 0.4(0.8) 1 1.0(1.1) 1 1.2(1.1) 1 1 p<0.01 vs pre-op score Heartburn resolves reliably with fundoplication. Atypical symptoms improve significantly after fundoplication but do not resolve as reliably as heartburn This suggest that patients with atypical symptoms may have co-factors causing those symptoms that are not addressed by fundoplication or have irreversible airway damage that does not completely resolve after operation This information is important in patient selection and patient education before antirefiux surgery.

Original languageEnglish (US)
Number of pages1
JournalGastrointestinal endoscopy
Volume43
Issue number4
DOIs
StatePublished - Jan 1 1996

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ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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