Traditional reflux parameters and not impedance monitoring predict outcome after fundoplication in extraesophageal reflux.

Francis DO, Goutte M, Slaughter JC, Garrett CG, Hagaman D, Holzman MD, Vaezi MF
Laryngoscope. 2011 121 (9): 1902-9

PMID: 22024842 · DOI:10.1002/lary.21897

OBJECTIVES/HYPOTHESIS - Fundoplication is considered in patients with refractory extraesophageal reflux symptoms. However, postoperative symptom resolution is inconsistent. This analysis investigates which presenting symptoms and preoperative objective parameters predict postoperative symptom improvement.

STUDY DESIGN - Retrospective cohort study.

METHODS - A total of 237 patients referred for extraesophageal reflux symptoms refractory to medical therapy underwent esophageal function testing. Fundoplication was performed in 27 patients with objective evidence of gastroesophageal reflux disease. Symptomatic improvement was assessed at postoperative intervals. Logistic regression determined which symptoms and objective parameters predicted improvement of the presenting extraesophageal reflux symptom.

RESULTS - Overall, 59% of patients reported at least partial improvement of their presenting extraesophageal symptom after fundoplication. Predictors of symptomatic improvement were the presence of heartburn with or without regurgitation concomitant to their primary presenting symptom (odds ratio [OR], 6.6; 95% confidence interval [CI], 0.97-44.9; P = .05) and pH < 4 more than 12% of a 24-hour period (OR, 10.5; 95% CI, 1.36-81.1; P = .02). Probability of postoperative extraesophageal reflux symptom improvement was 90% if both conditions were present.

CONCLUSIONS - Both heartburn with or without regurgitation and esophageal pH < 4 more than 12% of a 24-hour period predicted postfundoplication resolution of the presenting extraesophageal reflux symptom.

Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.

MeSH Terms (18)

Aged Analysis of Variance Chi-Square Distribution Electric Impedance Endoscopy, Digestive System Female Fundoplication Gastroesophageal Reflux Humans Hydrogen-Ion Concentration Logistic Models Male Manometry Middle Aged Monitoring, Ambulatory Predictive Value of Tests Retrospective Studies Treatment Outcome

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