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The effect of medical therapy and antireflux surgery on dysphagia in patients with gastroesophageal reflux disease without esophageal stricture.

Abstract

BACKGROUND

Poor esophageal body motility and trapping of the hernial sac by the hiatal crura are the major pathomechanisms of gastroesophageal reflux disease (GERD)-induced dysphagia. There is only little knowledge of the effect of medical therapy or antireflux surgery in reflux-induced dysphagia.

METHODS

Fifty-nine consecutive GERD patients with dysphagia were studied by means of a symptom questionnaire, endoscopy, barium swallow, esophageal manometry, and 24-hour pH monitoring of the esophagus. Patients had proton pump inhibitor therapy and cisapride for 6 months. After GERD relapsed following withdrawal of medical therapy, 41 patients decided to have antireflux surgery performed. The laparoscopic Nissen fundoplication was chosen in 12 patients with normal esophageal body motility and the laparoscopic Toupet fundoplication in 29 patients with impaired peristalsis. Dysphagia was assessed prior to treatment, at 6 months of medical therapy, and at 6 months after surgery.

RESULTS

Heartburn and esophagitis were effectively treated by medical and surgical therapy. Only surgery improved regurgitation. Dysphagia improved in all patients following surgery but only in 16 patients (27.1%) following medical therapy. Esophageal peristalsis was strengthened following antireflux surgery.

CONCLUSIONS

Medical therapy fails to control gastroesophageal reflux as it does not inhibit regurgitation. Thus, it has little effect on reflux-induced dysphagia. Surgery controls reflux and improves esophageal peristalsis. This may contribute to its superiority over medical therapy in the treatment of GERD-induced dysphagia.

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  • Authors+Show Affiliations

    ,

    Department of Surgery, University of Innsbruck, Austria.

    , , ,

    Source

    American journal of surgery 177:3 1999 Mar pg 189-92

    MeSH

    2-Pyridinylmethylsulfinylbenzimidazoles
    Adult
    Aged
    Anti-Ulcer Agents
    Benzimidazoles
    Cisapride
    Deglutition Disorders
    Drug Therapy, Combination
    Enzyme Inhibitors
    Esophageal Stenosis
    Female
    Follow-Up Studies
    Fundoplication
    Gastroesophageal Reflux
    Heartburn
    Humans
    Hydrogen-Ion Concentration
    Laparoscopy
    Male
    Manometry
    Middle Aged
    Omeprazole
    Pantoprazole
    Pressure
    Prospective Studies
    Proton Pump Inhibitors
    Sulfoxides
    Surveys and Questionnaires
    Treatment Outcome

    Pub Type(s)

    Comparative Study
    Journal Article

    Language

    eng

    PubMed ID

    10219852

    Citation

    Wetscher, G J., et al. "The Effect of Medical Therapy and Antireflux Surgery On Dysphagia in Patients With Gastroesophageal Reflux Disease Without Esophageal Stricture." American Journal of Surgery, vol. 177, no. 3, 1999, pp. 189-92.
    Wetscher GJ, Glaser K, Gadenstaetter M, et al. The effect of medical therapy and antireflux surgery on dysphagia in patients with gastroesophageal reflux disease without esophageal stricture. Am J Surg. 1999;177(3):189-92.
    Wetscher, G. J., Glaser, K., Gadenstaetter, M., Profanter, C., & Hinder, R. A. (1999). The effect of medical therapy and antireflux surgery on dysphagia in patients with gastroesophageal reflux disease without esophageal stricture. American Journal of Surgery, 177(3), pp. 189-92.
    Wetscher GJ, et al. The Effect of Medical Therapy and Antireflux Surgery On Dysphagia in Patients With Gastroesophageal Reflux Disease Without Esophageal Stricture. Am J Surg. 1999;177(3):189-92. PubMed PMID: 10219852.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - The effect of medical therapy and antireflux surgery on dysphagia in patients with gastroesophageal reflux disease without esophageal stricture. AU - Wetscher,G J, AU - Glaser,K, AU - Gadenstaetter,M, AU - Profanter,C, AU - Hinder,R A, PY - 1999/4/29/pubmed PY - 1999/4/29/medline PY - 1999/4/29/entrez SP - 189 EP - 92 JF - American journal of surgery JO - Am. J. Surg. VL - 177 IS - 3 N2 - BACKGROUND: Poor esophageal body motility and trapping of the hernial sac by the hiatal crura are the major pathomechanisms of gastroesophageal reflux disease (GERD)-induced dysphagia. There is only little knowledge of the effect of medical therapy or antireflux surgery in reflux-induced dysphagia. METHODS: Fifty-nine consecutive GERD patients with dysphagia were studied by means of a symptom questionnaire, endoscopy, barium swallow, esophageal manometry, and 24-hour pH monitoring of the esophagus. Patients had proton pump inhibitor therapy and cisapride for 6 months. After GERD relapsed following withdrawal of medical therapy, 41 patients decided to have antireflux surgery performed. The laparoscopic Nissen fundoplication was chosen in 12 patients with normal esophageal body motility and the laparoscopic Toupet fundoplication in 29 patients with impaired peristalsis. Dysphagia was assessed prior to treatment, at 6 months of medical therapy, and at 6 months after surgery. RESULTS: Heartburn and esophagitis were effectively treated by medical and surgical therapy. Only surgery improved regurgitation. Dysphagia improved in all patients following surgery but only in 16 patients (27.1%) following medical therapy. Esophageal peristalsis was strengthened following antireflux surgery. CONCLUSIONS: Medical therapy fails to control gastroesophageal reflux as it does not inhibit regurgitation. Thus, it has little effect on reflux-induced dysphagia. Surgery controls reflux and improves esophageal peristalsis. This may contribute to its superiority over medical therapy in the treatment of GERD-induced dysphagia. SN - 0002-9610 UR - https://www.unboundmedicine.com/medline/citation/10219852/The_effect_of_medical_therapy_and_antireflux_surgery_on_dysphagia_in_patients_with_gastroesophageal_reflux_disease_without_esophageal_stricture_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9610(99)00011-2 DB - PRIME DP - Unbound Medicine ER -