Gastroesophageal reflux disease (GERD) and chest pain
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Laparoscopic fundoplication cures heart-burn and regurgitation in patients with gastroesophageal reflux disease (GERD) but its effect on the chest pain that is also experienced by some patients is less clear. Confusion stems from the fact that it is difficult to determine preoperatively whether the chest pain is actually caused by the reflux. Therefore, we designed a study in patients with GERD and chest pain that would assess the value of pH monitoring in establishing a correlation between the symptom and the disease, 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.
Of 487 patients who underwent laparoscopic fundoplication for GERD at our institution between October 1992 and July 2000, 165 (34%) complained of chest pain in addition to heartburn and regurgitation. Their symptoms had been present for an average of 118 months. The pH monitoring tracings were analyzed for a correlation between episodes of reflux and chest pain. The mean length of follow-up was 13 months.
Among the 165 patients with chest pain, the relationship between pain and reflux during pH monitoring was as follows: 39 patients (group A) experienced no chest pain during the study; in 28 patients (group B), chest pain correlated with reflux in ≥40% of instances; in 98 patients (group C), chest pain correlated with reflux in ≥40% of instances. Chest pain improved post-operatively in 65% of group A patients, 79% of group B patients, and 96% of group C patients (group C vs A and B: p<0.05). Heartburn and regurgitation resolved or improved in 97% and 95% of patients, respectively.
These data show that pH monitoring helped to identify a relationship between chest pain and reflux; and when the two coincided, the chest pain was relieved by antireflux surgery.
Key wordsGastroesophageal reflux disease (GERD) Chest pain Esophageal manometry pH monitoring Antireflux surgery Esophagus Fundoplication
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