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Digestive Diseases and Sciences

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01.04.2011 | Original Article

Reflux Parameters as Modified by Laparoscopic Fundoplication in 40 Patients with Heartburn/Regurgitation Persisting Despite PPI Therapy: A Study Using Impedance-pH Monitoring

verfasst von: Marzio Frazzoni, Rita Conigliaro, Gianluigi Melotti

Erschienen in: Digestive Diseases and Sciences | Ausgabe 4/2011

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Abstract

Background

Patients with typical reflux symptoms (heartburn/regurgitation) persisting despite proton pump inhibitor (PPI) therapy are not uncommon. Impedance-pH monitoring detects gastroesophageal reflux at all pH levels and may establish if ongoing symptoms on PPI therapy are associated with acid/nonacid reflux. Laparoscopic fundoplication is a therapeutic option in such patients but reflux parameters on PPI therapy and after intervention and their relationship with symptom persistence/remission have been scarcely studied.

Aims

The aim of this study was to assess reflux parameters and their relationship with symptoms before and after laparoscopic fundoplication, on and off PPI therapy, respectively, in patients with PPI-unresponsive heartburn/regurgitation and with a positive symptom-reflux association and/or abnormal reflux parameters detected on PPI therapy.

Methods

Impedance-pH monitoring was performed on high-dose PPI therapy and 3 months after laparoscopic fundoplication, off PPI therapy, in 40 patients with PPI-unresponsive heartburn/regurgitation. Symptoms were scored by a validated questionnaire.

Results

Esophageal acid exposure time as well as the number of total and proximal reflux events and of acid and weakly acidic refluxes decreased significantly after surgery: normal values were found in 100, 77, 95, 92 and 65% of cases, respectively. Weakly alkaline refluxes increased significantly postoperatively but neither before nor after intervention were associated with symptoms. All patients reported total/subtotal remission of heartburn/regurgitation 3 months after surgery.

Conclusions

Laparoscopic fundoplication improves acid and weakly acidic reflux parameters when compared with PPI therapy. This improvement justifies the very high post-surgical symptom remission rate that we observed. Prolonged follow-up is warranted but our findings strongly support the surgical option in PPI failures.

DeVault KR, Castell DO. Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. Am J Gastroenterol. 2005;100:190–200.PubMedCrossRef

Fass R, Shapiro M, Dekel R, Sewell J. Systematic review: Proton-pump inhibitor failure in gastro-oesophageal reflux disease—where next? Aliment Pharmacol Ther. 2005;22:79–94.PubMedCrossRef

Fass R, Sifrim D. Management of heartburn not responding to proton pump inhibitors. Gut. 2009;58:295–309.PubMedCrossRef

Sifrim D, Holloway R, Silny J, et al. Acid, nonacid, and gas reflux in patients with gastroesophageal reflux disease during ambulatory 24-hour pH-impedance recordings. Gastroenterology. 2001;120:1588–1598.PubMedCrossRef

Vela M, Camacho-Lobato L, Srinivasan R, Tutuian R, Katz PO, Castell DO. Simultaneous intraesophageal impedance and pH measurement of acid and nonacid gastroesophageal reflux: Effect of omeprazole. Gastroenterology. 2001;120:1599–1606.PubMedCrossRef

Hirano I, Richter JE, The Practice Parameters Committee of the American College of Gastroenterology. ACG practice guidelines: Esophageal reflux testing. Am J Gastroenterol. 2007;102:668–685.PubMedCrossRef

Zerbib F, Bruley Des Varannes S, Roman S, et al. Normal values and day-to-day variability of 24-h ambulatory oesophageal impedance-pH monitoring in a Belgian–French cohort of healthy subjects. Aliment Pharmacol Ther. 2005;22:1011–1021.PubMedCrossRef

Mainie I, Tutuian R, Shay S, et al. Acid and non-acid reflux in patients with persistent symptoms despite acid suppressive therapy: A multicentre study using combined ambulatory impedance-pH monitoring. Gut. 2006;55:1398–1402.PubMedCrossRef

Zerbib F, Roman S, Ropert A, et al. Esophageal pH-impedance monitoring and symptom analysis in GERD: A study in patients off and on therapy. Am J Gastroenterol. 2006;101:1956–1963.PubMedCrossRef

10.

Bredenoord AG, Tutuian R, Smout AJPM, Castell DO. Technology review: Esophageal impedance monitoring. Am J Gastroenterol. 2006;101:1–8.CrossRef

11.

Castell DO. Reflux testing in the 21st century: Is there a role for pH only? Clin Gastroenterol Hepatol. 2008;6:840–841.PubMedCrossRef

12.

Pandolfino JE, Vela MF. Esophageal reflux monitoring. Gastrointest Endosc. 2009;69:917–930.PubMedCrossRef

13.

Frazzoni M, Grisendi A, Lanzani A, Melotti G, De Micheli E. Laparoscopic fundoplication versus lansoprazole for gastro-oesophageal reflux disease. A pH-metric comparison. Dig Liver Dis. 2002;34:99–104.PubMedCrossRef

14.

Frazzoni M, Lonardo A, Grisendi A, et al. Are routine duodenal and antral biopsies useful in the management of “functional” dyspepsia? A diagnostic and therapeutic study. J Clin Gastroenterol. 1993;17:101–108.PubMedCrossRef

15.

Sifrim D, Castell D, Dent J, Kahrilas PJ. Gastro-oesophageal reflux monitoring: Review and consensus report on detection and definitions of acid, non-acid, and gas reflux. Gut. 2004;53:1024–1031.PubMedCrossRef

16.

Kahrilas PJ, Shaheen NJ, Vaezi MF. American Gastroenterological Association Institute technical review on the management of gastroesophageal reflux disease. Gastroenterology. 2008;135:1392–1413.PubMedCrossRef

17.

Mainie I, Tutuian R, Agrawal A, Adams D, Castell DO. Combined multichannel intraluminal impedance-pH monitoring to select patients with persistent gastro-oesophageal reflux for laparoscopic Nissen fundoplication. Br J Surg. 2006;93:1483–1487.PubMedCrossRef

18.

Broeders JA, Draaisma WA, Bredenoord AJ, et al. Oesophageal acid hypersensitivity is not a contraindication to Nissen fundoplication. Br J Surg. 2009;96:1023–1030.PubMedCrossRef

19.

Hemmink GJM, Bredenoord AJ, Weusten BLAM, Monkelbaan JF, Timmer R, Smout AJPM. Esophageal pH-impedance monitoring in patients with therapy-resistant reflux symptoms: “on” or “off” proton pump inhibitor? Am J Gastroenterol. 2008;103:2446–2453.PubMedCrossRef

20.

Frazzoni M, Savarino E, Manno M, et al. Reflux patterns in patients with short segment Barrett’s oesophagus: A study using impedance-pH monitoring off and on proton pump inhibitor therapy. Aliment Pharmacol Ther. 2009;30:508–515.PubMedCrossRef

21.

Bredenoord AJ, Draaisma WA, Weusten BLAM, Gooszen HG, Smout AJPM. Mechanisms of acid, weakly acidic and gas reflux after anti-reflux surgery. Gut. 2008;57:161–166.PubMedCrossRef

22.

Zerbib F, Duriez A, Roman S, Capedont M, Mion F. Determinants of gastro-oesophageal reflux perception in patients with persistent symptoms despite proton pump inhibitors. Gut. 2008;57:156–160.PubMedCrossRef

23.

Tutuian R, Vela MF, Hill EG, Mainie I, Agrawal A, Castell DO. Characteristic of symptomatic acid reflux episodes on acid suppressive therapy. Am J Gastroenterol. 2008;103:1090–1096.PubMedCrossRef

24.

Scheffer RCH, Samsom M, Hebbard GS, Gooszen HG. Effects of partial (Belsey Mark IV) and complete (Nissen) fundoplication on proximal gastric function and esophagogastric junction dynamics. Am J Gastroenterol. 2006;101:479–487.PubMedCrossRef

25.

Roberts NB. Review article: Human pepsins—their multiplicity, function and role in reflux disease. Aliment Pharmacol Ther. 2006;24(Suppl. 2):2–9.PubMedCrossRef

26.

Bredenoord AJ, Weusten BLAM, Curvers WL, Timmer R, Smout AJPM. Determinants of perception of heartburn and regurgitation. Gut. 2006;55:313–318.PubMedCrossRef

27.

Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R, The Global Consensus Group. The Montreal definition and classification of gastroesophageal reflux disease: A global evidence-based consensus. Am J Gastroenterol. 2006;101:1900–1920.PubMedCrossRef

28.

Agrawal A, Roberts J, Sharma N, Tutuian R, Vela M, Castell DO. Symptoms with acid and nonacid reflux may be produced by different mechanisms. Dis Esophagus. 2009;22:467–470.PubMedCrossRef

29.

Aanen MC, Bredenoord AJ, Numans ME, Samson M, Smout AJPM. Reproducibility of symptom association analysis in ambulatory reflux monitoring. Am J Gastroenterol. 2008;103:2200–2208.PubMedCrossRef

30.

Pritchett JM, Aslam M, Slaughter JC, Ness RM, Garrett CG, Vaezi MF. Efficacy of esophageal impedance/pH monitoring in patients with refractory gastroesophageal reflux disease, on and off therapy. Clin Gastroenterol Hepatol. 2009;7:743–748.PubMedCrossRef

31.

Spechler JS. Surgery for gastroesophageal reflux disease: Esophageal impedance to progress? Clin Gastroenterol Hepatol. 2009;7:1264–1265.PubMedCrossRef

32.

Shay S, Tutuian R, Sifrim D, et al. Twenty-four hour ambulatory simultaneous impedance and pH-monitoring: A multicenter report of normal values from 60 healthy volunteers. Am J Gastroenterol. 2004;99:1037–1043.PubMedCrossRef

33.

Zentilin P, Iiritano E, Dulbecco P, et al. Normal values of 24-h ambulatory intraluminal impedance combined with pH-metry in subjects eating a Mediterranean diet. Dig Liver Dis. 2006;38:226–232.PubMedCrossRef

34.

Hila A, Agrawal A, Castell DO. Combined multichannel intraluminal impedance and pH esophageal testing compared to pH alone for diagnosing both acid and weakly acidic gastroesophageal reflux. Clin Gastroenterol Hepatol. 2007;5:172–177.PubMedCrossRef

35.

Campos GM, Peters JH, DeMeester TR, et al. Multivariate analysis of factors predicting outcome after laparoscopic Nissen fundoplication. J Gastrointest Surg. 1999;3:292–300.PubMedCrossRef

36.

Jackson PG, Gleiber MA, Askari R, Evans SR. Predictors of outcome in 100 consecutive laparoscopic antireflux procedures. Am J Surg. 2001;181:231–235.PubMedCrossRef

37.

Vakil N. Review article: The role of surgery in gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2007;25:1365–1372.PubMedCrossRef

38.

Roman S, Poncet G, Serray I, Zerbib F, Boulez J, Mion F. Characterization of reflux events after fundoplication using combined impedance-pH recording. Br J Surg. 2007;94:48–52.PubMedCrossRef

39.

Draaisma WA, Rijnhart-de Jong HG, Broeders IAMJ, Smout AJPM, Furnee EJB, Gooszen HG. Five-year subjective and objective results of laparoscopic and conventional Nissen fundoplication: A randomized trial. Ann Surg. 2006;244:34–41.PubMedCrossRef

Titel: Reflux Parameters as Modified by Laparoscopic Fundoplication in 40 Patients with Heartburn/Regurgitation Persisting Despite PPI Therapy: A Study Using Impedance-pH Monitoring
verfasst von: Marzio Frazzoni
Rita Conigliaro
Gianluigi Melotti
Publikationsdatum: 01.04.2011
Verlag: Springer US
Erschienen in: Digestive Diseases and Sciences / Ausgabe 4/2011
Print ISSN: 0163-2116
Elektronische ISSN: 1573-2568
DOI: https://doi.org/10.1007/s10620-010-1381-4

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