OGBN P44 Does laparoscopic fundoplication have a role in non-erosive reflux disease?

Abstract

Abstract Background Non-erosive reflux disease (NERD) is a sub-group of gastro-oesophageal reflux disease (GORD) characterised by reflux related symptoms without endoscopic evidence of oesophageal mucosal erosion. Management can be challenging as the prevalence of functional dyspepsia and IBS-related symptoms is often high. This study was undertaken to examine symptom control after laparoscopic fundoplication in patients with NERD compared to those with oesophagitis associated GORD. Methods Patients who underwent laparoscopic fundoplication for NERD or GORD with oesophagitis between January 2017 and January 2022 were included in this study. Patients were asked to score their current symptoms using the modified DeMeester Clinical Symptom Score (CSS) and Gastrointestinal Symptom Rating Scale (GSRS), and then rate their satisfaction with the procedure. Results 14 patients who underwent surgery for NERD and 31 with oesophagitis associated GORD were included in this study, with a mean follow up of 3.4 years and 2.7 years respectively after surgery. 86% of NERD patients and 94% of oesophagitis patients reported an improvement in symptoms after surgery. There was a trend for higher symptom scores in NERD patients (NERD patients CSS 4.57±1.95, oesophagitis patients CSS 3.45±1.79, p=0.065; NERD patients GSRS 1.99±0.37, oesophagitis patients GSRS 1.72±0.49, p=0.069). NERD patients with higher pre-operative DeMeester scores from pH testing had lower GSRS scores (r=-0.616, p=0.043). Conclusions With careful patient selection and detailed pre-operative counselling, surgery can play a role in the management of NERD patients. Whilst post-operative symptom control may not be as good as that achieved with classical oesophagitis associated GORD, these findings suggest that NERD patients do achieve symptom improvement after laparoscopic fundoplication. Further research is needed to help identify other factors that predict response to surgery in NERD to optimise patient selection and improve shared decision making.