Abstract
Background
The role of surgery in the management of extra-oesophageal symptoms of gastro-oesophageal reflux (EOR) is unclear. In this retrospective study we studied patients who had surgical fundoplication for EOR symptoms from 1995 to 2005. We analysed outcome with respect to symptomatic improvement and patient satisfaction.
Methods
From our database of 240 patients who had surgical fundoplication for gastro-oesophageal reflux disease, 51 patients who had predominantly EOR symptoms were identified. All the patients had objective evidence of reflux and had been offered surgery because of failure of medical therapy and/or of development of complications.
Patients were asked to score their symptoms before and after surgery using the Reflux Symptom Index, and to record their use of medicine before and after operation, their experience with surgery and their overall quality of life using a written questionnaire.
Results
Forty of the 51 patients were available for analysis. Common symptoms were cough and breathlessness (32/40), throat clearing/postnasal drip (31/40), sensation of lump in the throat (29/40), and voice problems (22/40). Of these forty patients, 34 (85%) had associated classical symptoms as well. Mean follow up at the time of questionnaire was 53.3 (6–120) months. The mean Reflux Symptom Index score improved from 22.80 (SD 10.80) to 11.83 (SD 9.91) (p < 0.0001, paired t-test).
Six of the 39 responders (15.3%) said they would not have had the operation knowing what they know now and that problems related to the operation outweighed any benefits. These problems included gas bloating, inability to retch and dysphagia lasting up to one year after surgery. Twenty-five percent of the 40 patients described their overall quality of life as excellent, 32.5% as good, 32.5% as satisfactory and 10% as bad.
Conclusion
Surgery can be an effective treatment in the majority of patients with extra-oesophageal symptoms of reflux.
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References
Allen CJ, Anvari M (2002) Preoperative symptom evaluation and esophageal acid infusion predict response to laparoscopic Nissen fundoplication in gastro-esophageal reflux patients who present with cough. Surg Endosc 16:1037–1041
Belfasky PC, Postma GN, Amin MR, Koufman JA (2002) Symptoms and findings of laryngopharyngeal reflux. Ear Nose Throat J 81:10–13
Drug VL, Cobzeanu D, Papaghuic C et al (2005) Gastro-oesophageal reflux involvement in ENT disorders. Rev Med Chir Soc Med Nat Iasi 109:220–222
Duffy JP Maggard M, Hiyama DT, Atkinson JB (2003) Laparoscopic Nissen fundoplication improves quality of life in patients with atypical symptoms of gastro-esophageal reflux. Am Surg 69:833–838
Farrel TM, Richardson WS, Trus TL, Smith CD, Hunter JG (2001) Response of atypical symptoms of gastro-oesophageal reflux to antireflux surgery. Br J Surg 88:1649–1652
Fernando HC, El-Sherif Amgad, Landreneau JR, Gilbert S et al (2005) Efficacy of laparoscopic fundoplication in controlling pulmonary symptoms associated with gastro-esophageal reflux disease. Surgery 138:612–617
Fuchs KH, DeMeester TR, Albertucci M (1987) Specificity and sensitivity of objective diagnosis of gastro-esophageal reflux disease. Surgery 102:575–580
Gadenstatter M, Wykypiel, Schwab GP, Profanter C, Wetscher GJ (1999) Respiratory symptoms and dysphagia in patients with gastro-oesophageal reflux disease: a comparison of medical and surgical therapy. Langenbach’s Arch Surg 384:563–567
James BY, Zeitels SM, Rattner DW (1998) Outcomes of atypical symptoms attributed to gastro-oesophageal reflux treated by laparoscopic fundoplication. Surgery 124:28–32
Johnson WE, Hagen JA, Demeester TR et al (1996) Outcome of respiratory symptoms after antireflux surgery on patients with gastro-esophageal reflux. Arch Surg 31:489–492
Novitsky YW, Zawacki JK, Irwin RS et al (2002) Chronic cough due to gastro-oesophageal reflux disease Efficacy of antireflux surgery. Surg Endosc 16:567–571
Poelmans J, Feenstra L, Tack J (2006) Determinants of long term outcome of patients with reflux related ear, nose and throat symptoms. Dig Dis Sci 51:282–288
Rakita S, Villadolid D, Thomas A, Bloomstan M, Albrinck M, Goldin S (2006) Laparoscopic Nissen fundoplication offers high patient satisfaction with relief of extra-esophageal symptoms of gastro-esophageal reflux disease. Am Surg 72:207–212
Richter JE (1998) Extra-oesophageal presentations of gastroesophageal reflux disease. Semin Gastrointest Dis 8:75–89
Sarela AI, Verbeke CS, Pring C, Guillou PJ (2004) Is symptom control the correct end point for proton pump inhibitor treatment in Barrets oesophagus? Gut 53:1387–1388
Westcott CJ, Hopkins MB, Bach K, Postma GN, Belafsky PC, Koufman JA (2004) Fundoplication for laryngopharyngeal reflux disease. J Am Coll Surg 199:23–30
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Iqbal, M., Batch, A.J., Moorthy, K. et al. Outcome of surgical fundoplication for extra-oesophageal symptoms of reflux. Surg Endosc 23, 557–561 (2009). https://doi.org/10.1007/s00464-008-9861-8
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DOI: https://doi.org/10.1007/s00464-008-9861-8