Impact of psychiatric disorders on patient satisfaction after Nissen Fundoplication
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Anxiety and depression have been associated with an increased perception of gastroesophageal reflux symptoms, but there is a paucity of data regarding the outcomes of laparoscopic Nissen Fundoplication (LNF) in this patient population.
We performed a retrospective cohort study including all patients undergoing LNF between 2011 and 2017. Patients were stratified by baseline usage of serotonin-modulating medication or benzodiazepines as a proxy for depression and anxiety, respectively. Outcome measures included postoperative gastroesophageal health-related quality of life (GERD-HRQL) scores and overall satisfaction rates after surgery. A p value of < 0.05 was considered statistically significant.
The population consisted of 271 patients of which 103 patients had depression and 44 patients had anxiety. Patients with depression reported no significant difference in pre- or postoperative GERD-HRQL scores compared to patients without depression and long-term satisfaction rates after surgery were similar in both groups at 76% vs 71%, respectively (p = 0.55). Patients with anxiety reported higher baseline HRQL scores (34 vs. 29, p = 0.05). At long-term follow-up (15 months), patients with anxiety reported slightly worse HRQL scores compared to controls (7 vs. 4, p = 0.11) despite no difference in usage of anti-acid medications or need for endoscopic dilations between the two groups. Patients with anxiety were less likely to report being “satisfied” after surgery (40% vs. 71%, p = 0.01) compared to controls.
Patients with anxiety have higher subjective reporting of GERD symptoms and are more likely to report being “satisfied” during long-term follow-up after LNF. Patients on medication for depression appear to have similar reporting of GERD symptoms and derive as much benefit from LNF as patients that are not. While LNF does improve the symptom burden in patients with anxiety, satisfaction is rarely achieved in long-term follow-up.
KeywordsAnxiety Depression Nissen Fundoplication Satisfaction
Compliance with ethical standards
Drs. Carla Holcomb, Noah Switzer, Anahita Jalilvand, Patricia Belle, Monet McNally, and Kyle Perry have no conflicts of interest or financial ties to disclose.
- 1.Peery AF, Crockett SD, Barritt AS, Dellon ES, Eluri S, Gangarosa LM, Jensen ET, Lund JL, Pasricha S, Runge T, Schmidt M, Shaheen NJ, Sandler RS (2015) Burden of gastrointestinal, liver, and pancreatic diseases in the United States. Gastroenterology 149(7):1731–1741. https://doi.org/10.1053/j.gastro.2015.08.045 (e1733) CrossRefGoogle Scholar
- 2.Kahrilas PJ, Shaheen NJ, Vaezi MF, Gastroenterological Association I, Clinical P, Quality Management C (2008) American Gastroenterological Association Institute technical review on the management of gastroesophageal reflux disease. Gastroenterology 135(4):1392–1413. https://doi.org/10.1053/j.gastro.2008.08.044 (e1391–1395) CrossRefGoogle Scholar
- 6.Martin-Merino E, Ruigomez A, Garcia Rodriguez LA, Wallander MA, Johansson S (2010) Depression and treatment with antidepressants are associated with the development of gastro-oesophageal reflux disease. Aliment Pharmacol Ther 31(10):1132–1140. https://doi.org/10.1111/j.1365-2036.2010.04280.x Google Scholar
- 11.Velanovich V, Vallance SR, Gusz JR, Tapia FV, Harkabus MA (1996) Quality of life scale for gastroesophageal reflux disease. J Am Coll Surg 183(3):217–224Google Scholar
- 15.Aro P, Talley NJ, Ronkainen J, Storskrubb T, Vieth M, Johansson SE, Bolling-Sternevald E, Agreus L (2009) Anxiety is associated with uninvestigated and functional dyspepsia (Rome III criteria) in a Swedish population-based study. Gastroenterology 137(1):94–100. https://doi.org/10.1053/j.gastro.2009.03.039 CrossRefGoogle Scholar
- 18.Rushnak MJ, Leevy CM (1980) Effect of diazepam on the lower esophageal sphincter. A double-blind controlled study. Am J Gastroenterol 73(2):127–130Google Scholar