Recurrent Symptoms after Fundoplication with a Negative pH Study—Recurrent Reflux or Functional Heartburn?
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A small cohort of patients present after antireflux surgery complaining of recurrent heartburn. Over two thirds of these patients will have a negative 24-h pH study. The aim of our study is to determine whether these patients have an associated functional disorder or abnormal cytokine activity and to examine the reproducibility of pH testing.
A prospective analysis was carried out on a cohort of patients who had undergone a fundoplication and postoperative pH testing for recurrent heartburn: group A—patients with recurrent heartburn and a negative 24-h pH study and group B (control group)—patients with recurrent heartburn and a positive pH study. Questionnaires, a blood sample, and repeat pH testing were completed.
Sixty-nine patients were identified. Group A’s depression score (8.6 ± 4.1) was significantly higher than group B’s (5.9 ± 4.2; P = 0.03). Cytokine levels were similar in both groups. Forty-seven of 49 (96%) patients who underwent repeat pH testing had a negative study. Symptom-reflux correlation was highly significant (P < 0.001).
Some patients with recurrent heartburn and a negative pH study have associated functional or psychiatric comorbidities such as depression. Reproducibility of 24-h pH testing in these patients is excellent.
KeywordsLaparoscopic fundoplication Recurrent heartburn Recurrent reflux 24-h pH study Antireflux surgery
We would like to thank Carolyn Lally for all her help in managing the Royal Adelaide Hospital fundoplication database and Janet Pinno, Lorelle Smith, and Nicky Ascott for their hard work in completing the postoperative follow-up for all patients in the database. We would also like to acknowledge the diligent work of Tobias Liebregts and Birgit Adam in analyzing the blood samples.
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