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Recurrent Symptoms after Fundoplication with a Negative pH Study—Recurrent Reflux or Functional Heartburn?

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

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.

Methods

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.

Results

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).

Conclusion

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.

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Acknowledgments

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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Authors and Affiliations

  1. Discipline of Surgery, University of Adelaide, Adelaide, South Australia, Australia

    Sarah K. Thompson, Glyn G. Jamieson, Alison Y. Zhang, Jennifer C. Myers, Zoe E. Parr & Peter G. Devitt

  2. Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia

    Jenny Persson & Gerald Holtmann

  3. Department of Surgery, Flinders University, Bedford Park, Adelaide, South Australia, Australia

    Wang Cai & David I. Watson

  4. Department of Surgery, Royal Adelaide Hospital, Level 5, Eleanor Harrald Building, Adelaide, South Australia, 5000, Australia

    Sarah K. Thompson

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  1. Sarah K. Thompson
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Correspondence to Sarah K. Thompson.

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Thompson, S.K., Cai, W., Jamieson, G.G. et al. Recurrent Symptoms after Fundoplication with a Negative pH Study—Recurrent Reflux or Functional Heartburn?. J Gastrointest Surg 13, 54–60 (2009). https://doi.org/10.1007/s11605-008-0653-1

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  • DOI: https://doi.org/10.1007/s11605-008-0653-1

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