The outcome of fundoplication in patients with GERD based on abnormal impedance testing
Introduction The role of impedance testing in selecting patients for antireflux surgery is poorly understood. The aim of this study was to compare the outcomes of patients that underwent antireflux surgery for GERD based on an abnormal pH/abnormal impedance test versus a normal pH/abnormal impedance...
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Published in | Surgical endoscopy Vol. 34; no. 6; pp. 2601 - 2607 |
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Main Authors | , , , , , , , , |
Format | Journal Article |
Language | English |
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Springer US
01.06.2020
Springer Nature B.V |
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Abstract | Introduction
The role of impedance testing in selecting patients for antireflux surgery is poorly understood. The aim of this study was to compare the outcomes of patients that underwent antireflux surgery for GERD based on an abnormal pH/abnormal impedance test versus a normal pH/abnormal impedance test.
Methods
Records of patients who had an abnormal off-medication impedance test (≥ 48 total reflux events) who underwent antireflux surgery were reviewed and divided into two groups: normal
[pH−]
or abnormal
[pH+]
esophageal acid exposure (DeMeester score > 14.7). Symptom resolution was compared: scale 1 (no resolution) to 5 (complete resolution).
Results
Eighty-two patients met criteria: 44
[pH+]
and 38
[pH−]
. There were no differences in the demographics or indications for surgery. The frequencies of heartburn and regurgitation symptoms were significantly reduced by fundoplication in both groups. Complete resolution of heartburn was more common in the
[pH+]
group (90%) compared to the
[pH−]
group (67%) [
p
= 0.02]. Resolution of regurgitation was similar in both groups (90% in the
[pH+]
group vs 79% in the
[pH−]
group,
p
= 0.20). The mean dysphagia frequency score decreased for the
[pH+]
group, but increased in the
[pH−]
group. New-onset dysphagia was more common in
[pH−]
patients (23%) compared to
[pH+]
patients (5%), (
p
= 0.02). Continued use of PPI medications was significantly more likely in
[pH−]
group (42%) compared to the
[pH+]
group (21%). There was no difference in surgical satisfaction rates between groups.
Discussion
Patients with abnormal impedance and increased esophageal acid exposure had significantly better symptom resolution, less dysphagia, and less frequent PPI use with antireflux surgery versus those with normal pH. These findings urge caution in the use of abnormal impedance values with normal esophageal acid exposure for the selection of patients for an antireflux operation. |
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AbstractList | The role of impedance testing in selecting patients for antireflux surgery is poorly understood. The aim of this study was to compare the outcomes of patients that underwent antireflux surgery for GERD based on an abnormal pH/abnormal impedance test versus a normal pH/abnormal impedance test.
Records of patients who had an abnormal off-medication impedance test (≥ 48 total reflux events) who underwent antireflux surgery were reviewed and divided into two groups: normal [pH-] or abnormal [pH+] esophageal acid exposure (DeMeester score > 14.7). Symptom resolution was compared: scale 1 (no resolution) to 5 (complete resolution).
Eighty-two patients met criteria: 44 [pH+] and 38 [pH-]. There were no differences in the demographics or indications for surgery. The frequencies of heartburn and regurgitation symptoms were significantly reduced by fundoplication in both groups. Complete resolution of heartburn was more common in the [pH+] group (90%) compared to the [pH-] group (67%) [p = 0.02]. Resolution of regurgitation was similar in both groups (90% in the [pH+] group vs 79% in the [pH-] group, p = 0.20). The mean dysphagia frequency score decreased for the [pH+] group, but increased in the [pH-] group. New-onset dysphagia was more common in [pH-] patients (23%) compared to [pH+] patients (5%), (p = 0.02). Continued use of PPI medications was significantly more likely in [pH-] group (42%) compared to the [pH+] group (21%). There was no difference in surgical satisfaction rates between groups.
Patients with abnormal impedance and increased esophageal acid exposure had significantly better symptom resolution, less dysphagia, and less frequent PPI use with antireflux surgery versus those with normal pH. These findings urge caution in the use of abnormal impedance values with normal esophageal acid exposure for the selection of patients for an antireflux operation. IntroductionThe role of impedance testing in selecting patients for antireflux surgery is poorly understood. The aim of this study was to compare the outcomes of patients that underwent antireflux surgery for GERD based on an abnormal pH/abnormal impedance test versus a normal pH/abnormal impedance test.MethodsRecords of patients who had an abnormal off-medication impedance test (≥ 48 total reflux events) who underwent antireflux surgery were reviewed and divided into two groups: normal [pH−] or abnormal [pH+] esophageal acid exposure (DeMeester score > 14.7). Symptom resolution was compared: scale 1 (no resolution) to 5 (complete resolution).ResultsEighty-two patients met criteria: 44 [pH+] and 38 [pH−]. There were no differences in the demographics or indications for surgery. The frequencies of heartburn and regurgitation symptoms were significantly reduced by fundoplication in both groups. Complete resolution of heartburn was more common in the [pH+] group (90%) compared to the [pH−] group (67%) [p = 0.02]. Resolution of regurgitation was similar in both groups (90% in the [pH+] group vs 79% in the [pH−] group, p = 0.20). The mean dysphagia frequency score decreased for the [pH+] group, but increased in the [pH−] group. New-onset dysphagia was more common in [pH−] patients (23%) compared to [pH+] patients (5%), (p = 0.02). Continued use of PPI medications was significantly more likely in [pH−] group (42%) compared to the [pH+] group (21%). There was no difference in surgical satisfaction rates between groups.DiscussionPatients with abnormal impedance and increased esophageal acid exposure had significantly better symptom resolution, less dysphagia, and less frequent PPI use with antireflux surgery versus those with normal pH. These findings urge caution in the use of abnormal impedance values with normal esophageal acid exposure for the selection of patients for an antireflux operation. INTRODUCTIONThe role of impedance testing in selecting patients for antireflux surgery is poorly understood. The aim of this study was to compare the outcomes of patients that underwent antireflux surgery for GERD based on an abnormal pH/abnormal impedance test versus a normal pH/abnormal impedance test. METHODSRecords of patients who had an abnormal off-medication impedance test (≥ 48 total reflux events) who underwent antireflux surgery were reviewed and divided into two groups: normal [pH-] or abnormal [pH+] esophageal acid exposure (DeMeester score > 14.7). Symptom resolution was compared: scale 1 (no resolution) to 5 (complete resolution). RESULTSEighty-two patients met criteria: 44 [pH+] and 38 [pH-]. There were no differences in the demographics or indications for surgery. The frequencies of heartburn and regurgitation symptoms were significantly reduced by fundoplication in both groups. Complete resolution of heartburn was more common in the [pH+] group (90%) compared to the [pH-] group (67%) [p = 0.02]. Resolution of regurgitation was similar in both groups (90% in the [pH+] group vs 79% in the [pH-] group, p = 0.20). The mean dysphagia frequency score decreased for the [pH+] group, but increased in the [pH-] group. New-onset dysphagia was more common in [pH-] patients (23%) compared to [pH+] patients (5%), (p = 0.02). Continued use of PPI medications was significantly more likely in [pH-] group (42%) compared to the [pH+] group (21%). There was no difference in surgical satisfaction rates between groups. DISCUSSIONPatients with abnormal impedance and increased esophageal acid exposure had significantly better symptom resolution, less dysphagia, and less frequent PPI use with antireflux surgery versus those with normal pH. These findings urge caution in the use of abnormal impedance values with normal esophageal acid exposure for the selection of patients for an antireflux operation. Introduction The role of impedance testing in selecting patients for antireflux surgery is poorly understood. The aim of this study was to compare the outcomes of patients that underwent antireflux surgery for GERD based on an abnormal pH/abnormal impedance test versus a normal pH/abnormal impedance test. Methods Records of patients who had an abnormal off-medication impedance test (≥ 48 total reflux events) who underwent antireflux surgery were reviewed and divided into two groups: normal [pH−] or abnormal [pH+] esophageal acid exposure (DeMeester score > 14.7). Symptom resolution was compared: scale 1 (no resolution) to 5 (complete resolution). Results Eighty-two patients met criteria: 44 [pH+] and 38 [pH−] . There were no differences in the demographics or indications for surgery. The frequencies of heartburn and regurgitation symptoms were significantly reduced by fundoplication in both groups. Complete resolution of heartburn was more common in the [pH+] group (90%) compared to the [pH−] group (67%) [ p = 0.02]. Resolution of regurgitation was similar in both groups (90% in the [pH+] group vs 79% in the [pH−] group, p = 0.20). The mean dysphagia frequency score decreased for the [pH+] group, but increased in the [pH−] group. New-onset dysphagia was more common in [pH−] patients (23%) compared to [pH+] patients (5%), ( p = 0.02). Continued use of PPI medications was significantly more likely in [pH−] group (42%) compared to the [pH+] group (21%). There was no difference in surgical satisfaction rates between groups. Discussion Patients with abnormal impedance and increased esophageal acid exposure had significantly better symptom resolution, less dysphagia, and less frequent PPI use with antireflux surgery versus those with normal pH. These findings urge caution in the use of abnormal impedance values with normal esophageal acid exposure for the selection of patients for an antireflux operation. |
Author | Abdelmoaty, W. F. Creasey, H. Setthavongsack, N. Reavis, K. M. Glasgow, M. E. Demeester, S. R. Dunst, C. M. Davila Bradley, D. Swanstrom, L. L. |
Author_xml | – sequence: 1 givenname: M. E. surname: Glasgow fullname: Glasgow, M. E. organization: Bates College – sequence: 2 givenname: C. M. orcidid: 0000-0002-8320-5428 surname: Dunst fullname: Dunst, C. M. email: cdunst@orclinic.com organization: The Foundation for Surgical Innovation and Education, Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic – sequence: 3 givenname: W. F. surname: Abdelmoaty fullname: Abdelmoaty, W. F. organization: The Foundation for Surgical Innovation and Education, Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic – sequence: 4 givenname: N. surname: Setthavongsack fullname: Setthavongsack, N. organization: The Foundation for Surgical Innovation and Education – sequence: 5 givenname: H. surname: Creasey fullname: Creasey, H. organization: The Foundation for Surgical Innovation and Education – sequence: 6 givenname: D. surname: Davila Bradley fullname: Davila Bradley, D. organization: The Foundation for Surgical Innovation and Education, Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic – sequence: 7 givenname: K. M. surname: Reavis fullname: Reavis, K. M. organization: The Foundation for Surgical Innovation and Education, Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic – sequence: 8 givenname: L. L. surname: Swanstrom fullname: Swanstrom, L. L. organization: The Foundation for Surgical Innovation and Education, Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic – sequence: 9 givenname: S. R. surname: Demeester fullname: Demeester, S. R. organization: The Foundation for Surgical Innovation and Education, Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic |
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Cites_doi | 10.1016/S1091-255X(99)80071-7 10.1159/000209220 10.1007/s11605-011-1741-1 10.1007/s11605-019-04148-6 10.1002/bjs.5493 10.1111/nmo.12620 10.1016/j.dld.2005.12.011 10.1016/j.gie.2008.09.022 10.1097/MCG.0b013e31815f8e17 10.1111/j.1365-2036.2005.02677.x 10.1136/gut.2004.051821 10.1111/j.1572-0241.2003.07665.x 10.1111/j.1365-2982.1991.tb00061.x 10.1016/j.cgh.2008.08.020 10.1053/j.gastro.2008.08.045 10.1097/MCG.0b013e318194592b |
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Keywords | GERD pH testing Esophageal impedance testing Antireflux surgery |
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The role of impedance testing in selecting patients for antireflux surgery is poorly understood. The aim of this study was to compare the outcomes... The role of impedance testing in selecting patients for antireflux surgery is poorly understood. The aim of this study was to compare the outcomes of patients... IntroductionThe role of impedance testing in selecting patients for antireflux surgery is poorly understood. The aim of this study was to compare the outcomes... INTRODUCTIONThe role of impedance testing in selecting patients for antireflux surgery is poorly understood. The aim of this study was to compare the outcomes... |
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SubjectTerms | 2019 SAGES Oral Abdominal Surgery Dysphagia Esophagus Gastroenterology Gastroesophageal reflux Gynecology Hepatology Medicine Medicine & Public Health Proctology Surgery |
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Title | The outcome of fundoplication in patients with GERD based on abnormal impedance testing |
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