Improvement In Reflux Symptoms Research Articles

Is Roux-en- Y gastric bypass safe after previous antireflux surgery? Technical feasibility and postoperative symptom assessment

Background Clinically significant morbid obesity is associated with an increased risk of gastroesophageal reflux disease. Vertical Roux-en- Y gastric bypass (RYGBP) is known to eliminate acid (and bile) in the pouch of cardia, which would provide control of reflux symptoms. The aim of our study was to assess the technical considerations, morbidity, and safety of RYGBP after previous antireflux surgery and evaluate postoperative reflux symptoms. Methods Retrospective review of all patients undergoing RYGBP after previous antireflux surgery from three institutions. Follow-up (mean 18 months) data were obtained from medical records and by questionnaire. Results A total of 19 patients (18 women and 1 man) underwent standard (n = 18) or distal (n = 1) RYGBP 8 ± 1 years after Nissen (n = 18) or Toupet (n = 1) fundoplication. Open RYGBP was undertaken in 17 of 19 patients. No postoperative deaths occurred. Substantive complications occurred in 4 patients (21%) and included hemorrhage requiring transfusion, concomitant splenectomy, and reoperation for suspected leak in 2. Of the 19 patients, 16 returned the questionnaire, 15 of whom reported subjective improvement in reflux symptoms after RYGBP compared with after antireflux surgery. No patient in this series required medical therapy for reflux symptoms at the last follow-up visit. The body mass index decreased from 42 ± 2 kg/m 2 to 32 ± 2 kg/m 2 (mean ± SEM); all patients with ≥1 year of follow-up had a body mass index of ≤32 kg/m 2. At last follow-up, 88% of patients were very satisfied subjectively with their outcome. Conclusions RYGBP after previous antireflux surgery is technically feasible and safe, but it is associated with greater complication rates than those seen with other forms of reoperative bariatric procedures. RYGBP results in effective weight loss, controls reflux symptoms, and may be the procedure of choice in morbidly obese patients with previous antireflux surgery, and obese patients requiring surgical treatment for gastroesophageal reflux disease.

Proton pump inhibitor therapy for chronic laryngo-pharyngitis: A randomized placebo-control trial

Objective To determine the efficacy of proton-pump inhibitor (PPI) therapy for chronic laryngo-pharyngitis treated with lifestyle modification. Study design and methods Double-blind, randomized trial comparing two-month Rabeprazole (20 mg b.i.d.) to placebo control. Results Compared to baseline, both PPI and control patients had significant improvement in total reflux symptoms ( P = 0.002 and P = 0.03 respectively), with significant improvement in “laryngo-pharyngeal” but not “typical” reflux symptoms. No significant difference was noted for change in reflux symptoms between PPI-treated and control patients ( P = 0.44). Significant global improvement was noted by 50% of control and 53% of PPI-treated patients ( P = 1.0). No significant differences were noted within or between treatment groups for change in health status or videostrobolaryngoscopy grade. Lifestyle modification compliance correlated significantly with global improvement. Conclusion Compared to baseline, lifestyle modification for 2 months significantly improved chronic laryngo-pharyngitis symptoms. When compared to control, treatment with a PPI failed to demonstrate significantly greater improvement in reflux symptoms, health status, or laryngeal appearance.

A CONSULTATIVE GASTROENTEROLOGIST (CG) PERSPECTIVE ON POST-MYOTOMY SYMPTOMS IN ACHALASIA PATIENTS

Purpose: Heller myotomy is a frequent treatment for achalasia. Persistent or new symptoms after myotomy represent a complicated problem facing the CG. The aim of this study is to identify the characteristics of patients with post-myotomy symptoms. Methods: Retrospective review of 11 patients (4 males, 7 females; mean age 48 yrs) seen in one CG practice for post-myotomy symptoms. Patients divided into: - Persistent symptoms: persistent dysphagia after surgery. - New symptoms: new heartburn and regurgitation after surgery. Results: Persistent symptoms: 8 patients; all had persistent dysphagia as their only symptom after myotomy. All of these patients had a Heller myotomy combined with a fundoplication. They all reported worsening of their dysphagia 2 months to 2 years after the surgery. Pneumatic dilatations of the lower esophageal sphincter (LES) were performed in all these patients with no improvement or only a short-lived (less than 2 months) symptom improvement. 3 patients also had LES Botox injections with no symptom improvement. Two of these patients have required esophagectomy. - New symptoms: 3 patients; All had persistent dysphagia after myotomy, but also complained of new heartburn and regurgitation symptoms. All of these patients did not have a fundoplication with the myotomy. Only one patient had an improvement in reflux symptoms with a proton pump inhibitor. Conclusions: Failed myotomy occurs and often results in referral to a CG. Follow-up of myotomy patients is important to identify persistent or new symptoms.

A Proton-Pump Inhibitor, Rabeprazole, Improves Ventilatory Function in Patients with Asthma Associated with Gastroesophageal Reflux

Background: Treatment of gastroesophageal reflux (GER) with proton-pump inhibitors (PPI) improves symptoms of asthma in some patients. However, the effects of a PPI on ventilatory function are still controversial. In this study, we measured ventilatory function in asthma patients treated with a PPI in order to identify those in whom a therapeutic effect on asthma can be expected from the acid suppression. Methods: From a cohort of 114 consecutive patients with bronchial asthma, 53 patients agreed to participate in the study and were treated with rabeprazole 20 mg daily for 8 weeks during an asymptomatic, stable period with no exacerbations of their asthma. Of the 53 patients, 22 were diagnosed as GER on the basis of the QUEST questionnaire and endoscopic examination. The patients were monitored for improvement in ventilatory function. Results: Four patients dropped out because of adverse drug reactions. All the patients with GER noted an improvement in reflux symptoms with PPI treatment. An improvement of more than 20% in peak expiratory flow (PEF) was observed in 8 of 21 GER patients but in none of the non-GER patients. Factors predictive of improvement in PEF with rabeprazole therapy were the QUEST score (odds ratio: 1.47, 95% CI: 1.06-2.04, P = 0.022) and steroid-dependency of asthma (odds ratio: 0.01, 95% CI: 0.001-0.31, P = 0.008). Conclusions: Treatment with rabeprazole is expected to ameliorate asthma in non-steroid-dependent patients who have symptomatic GER defined by the QUEST score.

Improvement of reflux symptoms 3 years after cure of Helicobacter pylori infection: a case-controlled study in the Japanese population.

Development of reflux esophagitis is one of the adverse effects that cause concern in relation to curative treatment of Helicobacter pylori infection. However, recent studies present a rather negative association between curative treatment and development of reflux esophagitis or reflux symptoms. Therefore, this issue has remained controversial. Accordingly, we investigated the long-term adverse effects of H. pylori eradication treatment in special reference to development of reflux symptoms. We conducted a case controlled study by mailing structured questionnaires on past (before curative treatment or 3 years previously) and current status. A case was an endoscopically confirmed peptic ulcer patient with confirmed cure of the infection after eradication treatment 3 years previously and a control was one who had not undergone the eradication treatment during the same period. We studied 241 pairs who matched for age, gender, and type of ulcer disease (GU, DU or GDU). Of these pairs, 81.3% were male and the mean age was 52.6 +/- 9.6 year (range 23-76). The rates of patients with improved reflux symptoms in the case and control groups were 65.4% and 30.4%, respectively, with the rate being significantly greater in the case group. On the contrary, the rates of those with worsened reflux symptoms were similar (5.1% and 7.6%). Regarding general events, the rate of patients with decreased frequency of hospital visits and of those who regularly used antiacid medications were significantly decreased in the case group. Furthermore, the case group experienced significantly fewer hospital admissions for various diseases in this 3-year period. However, a significantly greater number of case group patients than control subjects gained weight. Reflux symptoms as well as general well-being were significantly improved after cure of H. pylori infection.

Comparison of symptomatic and quality of life outcomes of laparoscopic versus open antireflux surgery

Even though laparoscopic antireflux procedures have become the surgical treatment of choice for gastroesophageal reflux disease (GERD), little quantitative data exist comparing symptomatic and quality of life outcomes between laparoscopic and standard open procedures. This study was done to compare short-term outcomes. All patients referred for surgical treatment of GERD are prospectively followed with a disease-specific reflux symptom score (the GERD-HRQL, best score 0, worst score 50) and a generic quality of life questionnaire (the SF-36, best score 100, worst score 0). Patients are evaluated preoperatively and at least 6 weeks postoperatively. Patients were treated with either laparoscopic or open Nissen (360-degree wrap) or Toupet (270-degree wrap) fundoplications. Sixty patients underwent laparoscopic surgery (LS) and 20 open surgery (OS). LS and OS had significant improvement in the median GERD-HRQL scores, 27 to 3 and 27 to 1, respectively, both P < .000001. LS had statistically significant improvements in the SF-36 domains of mental health (62 to 71.5, P = .05) and general health (57 to 67, P = .004). There was no worsening in any of the other 6 domains. OS produced a worsening score in the domain of physical functioning (75 to 67.5, P = .02). LS had better postoperative scores compared with OS in the domains of physical functioning (80 vs 67.5, P = .05) and trended to better scores in bodily pain (64 vs 51.5, P = .09). LS produces equivalent improvement in reflux symptoms compared with OS, with improved general quality of life outcomes.

Comparison of symptomatic and quality of life outcomes of laparoscopic versus open antireflux surgery

<h2>Abstract</h2> <b>Background:</b> Even though laparoscopic antireflux procedures have become the surgical treatment of choice for gastroesophageal reflux disease (GERD), little quantitative data exist comparing symptomatic and quality of life outcomes between laparoscopic and standard open procedures. This study was done to compare short-term outcomes. <b>Methods:</b> All patients referred for surgical treatment of GERD are prospectively followed with a disease-specific reflux symptom score (the GERD-HRQL, best score 0, worst score 50) and a generic quality of life questionnaire (the SF-36, best score 100, worst score 0). Patients are evaluated preoperatively and at least 6 weeks postoperatively. Patients were treated with either laparoscopic or open Nissen (360-degree wrap) or Toupet (270-degree wrap) fundoplications. <b>Results:</b> Sixty patients underwent laparoscopic surgery (LS) and 20 open surgery (OS). LS and OS had significant improvement in the median GERD-HRQL scores, 27 to 3 and 27 to 1, respectively, both <i>P</i> < .000001. LS had statistically significant improvements in the SF-36 domains of mental health (62 to 71.5, <i>P</i> = .05) and general health (57 to 67, <i>P</i> = .004). There was no worsening in any of the other 6 domains. OS produced a worsening score in the domain of physical functioning (75 to 67.5, <i>P</i> = .02). LS had better postoperative scores compared with OS in the domains of physical functioning (80 vs 67.5, <i>P</i> = .05) and trended to better scores in bodily pain (64 vs 51.5, <i>P</i> = .09). <b>Conclusions:</b> LS produces equivalent improvement in reflux symptoms compared with OS, with improved general quality of life outcomes. (Surgery 1999;126:782-9.)

Evaluation of laparoscopic Toupet fundoplication as a primary repair for all patients with medically resistant gastroesophageal reflux.

This prospective study assesses the outcome results in 100 consecutive patients with gastroesophageal reflux disease (GERD) treated with a laparoscopic Toupet fundoplication. GERD was confirmed by 24-h pH study and/or esophagogastroduodenoscopy (EGD). Pre- and postoperative symptoms, operative times, and perioperative complications were recorded on standardized data forms. Early follow-up was at 3 months and late follow-up, including 24-h pH, manometry, and EGD was at 22 months. Preoperative symptoms included heartburn (92%), regurgitation (58%), water brash (39%), and dysphagia (39%). Mean operative time was 3.2 hours. There were no conversions to celiotomy and there were no mortalities. The perioperative complication rate was 14%; 6% (5/83) of patients reported heartburn at 3 months and 20% (15/74) at 22 months. Early and late dysphagia was 20% (17/83) and 9% (7/74), respectively; 24-h pH testing was abnormal in 90% of symptomatic patients (9/10), 39% of asymptomatic patients (12/31), and 51% overall. Despite early improvement in reflux symptoms following laparoscopic Toupet fundoplications, there is a high incidence of recurrent GERD. Symptomatic follow-up underestimates the true incidence of 24-h pH-documented reflux. Based on these results we cannot recommend the laparoscopic Toupet repair for GERD patients with normal esophageal motility.