Upright gastroesophageal reflux: Is surgery indicated?

Abstract

Pure upright gastroesophageal reflux has not been treated surgically in the past because it was seen as physiologic and is associated with aerophagia which may lead to gas bloat, postoperatively. We have identified patients with esophageal injury resulting from upright reflux, and for the past three years have treated these patients similarly to supine and mixed refluxers. The purpose of this study was to determine the extent of esophageal injury and assess the operative outcome of patients undergoing antireflux procedures for pure upright reflux. METHODS: A prospective analysis of symptoms, esophageal function, and esophageal injury was performed in all surgically treated patients found to have pure upright reflux (reflux time >8.2% in upright position and - 3 months, but were noted only once a week and were easily relieved by medication and eructation. CONCLUSION: Pure uptight reflux can lead to esophageal mucosal injury. Operative therapy in patients with this condition is effective and can be accomplished with minimal morbidity. Postoperative gas bloat occurs with the same frequency in upright refluxers as it does in all others undergoing antireflux surgery.