PRE-OPERATIVE CLINICAL AND PARACLINICAL EXAMINATION IN ANTI-REFLUX SURGERY – DETERMINATION OF PREDICTIVE FACTORS (LITERATURE REVIEW)

Abstract

Objectives. Gastro-esophageal reflux disease is nowadays a highly prevalent, chronic condition, with 10% to 30% of Western populations affected by weekly symptoms. The standard treatment for gastro-esophageal reflux disease includes lifestyle modifications, dietary changes and antisecretory medication. However, in case of gastro-esophageal reflux disease refractory to conservative treatment, different endoscopic and surgical methods of treatment are indicated. Laparoscopic fundoplication is currently the most commonly performed anti-reflux operation for management of gastro-esophageal reflux disease. Outcomes, described in current literature, following laparoscopic fundoplication, indicate that it is highly effective for the treatment of gastro-esophageal reflux disease; early clinical studies demonstrate relief of symptoms in approximately 85-90% of patients. However, it is still unclear which factors, clinical or instrumental, are able to predict a good outcome after surgery. Thus, we conducted a literature review of studies aimed to identify the factors that predict success of anti-reflux surgery. Materials and Methods. A structured search was performed in the PubMed electronic database, taking into account relevant articles, published in the last 20 years. The search terms used (in English) were: ”gastroesophageal reflux disease”, ”GERD”, ”preoperative examination”, ”laparoscopic anti-reflux surgery”, ”Nissen fundoplication”, ”fundoplication predictor factors”, ”outcome predictors”, ”esophageal 24h pH monitoring”, ”esophageal pH-impedance monitoring”. Results. Practically, all demographic, esophagogastric junction anatomic conditions, clinical features (such as typical or atypical symptoms presence), as well as instrumental data (such as presence of esophagitis at endoscopy, or motility patterns determined by esophageal high resolution manometry or reflux patterns determined by means of impedance-pH monitoring) of patients undergoing laparoscopic fundoplication for gastro-esophageal reflux disease can be factors associated with symptomatic relief and a high patient satisfaction rate. Conclusions. The predictability of success after laparoscopic fundoplication is directly proportional to the level of certainty that gastro-esophageal reflux disease is the root cause of the patient's symptoms. Pre-operative paraclinical examination is mandatory, due to its ability to better stratify patients with gastro-esophageal reflux disease and to establish the association of symptoms with gastroesophageal reflux.