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Outcomes of antireflux surgery in patients with normal preoperative 24-hour pH test results.
Am J Surg 2004; 187(5):599-603AJ

Abstract

OBJECTIVE

Preoperative 24-hour pH testing is controversial in surgical patients who have symptomatic gastroesophageal reflux disease (GERD) and endoscopic evidence of esophagitis. The objective of this study was to compare the clinical outcomes of Nissen fundoplication for symptomatic reflux between patients with normal and abnormal preoperative pH testing.

METHODS

Patients were selected from a prospective database of patients who underwent laparoscopic esophageal procedures between January 1997 and December 2001 at our institution. Only patients having typical symptoms of GERD (heartburn and/or reflux), preoperative pH testing, manometry, and endoscopy and who had at least 6 months of post-operative follow-up were included in the study. Fifteen patients had normal preoperative DeMeester scores (DMS) (median 11.4, range 3.3 to 14.7). These were compared with 208 consecutive patients having abnormal preoperative DMS (median 49.6, range 15.2 to 250). Logistic regression modeling was performed to identify variables significant for poor outcome. Differences between means were tested using appropriate parametric or nonparametric tests.

RESULTS

There were no statistically significant differences in demographics, preoperative symptom score (mean 2.9 +/- 1.1 vs. 3.1 +/- 0.68, P = 0.30), or preoperative grade of esophagitis (P = 0.37) between the 2 groups. After a median follow-up of 8.8 months (range 6 to 36), 6 (40%) of the patients having normal preoperative DMS and 17 (8.1%) of the patients having abnormal preoperative DMS continued to have typical GERD symptoms (P <0.01, B error = 0.02). The most significant factor for poor outcome in the regression model was normal preoperative pH (odds ratio 9.02, P <0.01).

CONCLUSIONS

Symptomatic GERD patients with normal preoperative 24-hour pH test results have significantly worse subjective outcomes after Nissen fundoplication compared with patients having abnormal preoperative pH test results. To minimize poor symptomatic outcomes after antireflux surgery, a policy of routine preoperative pH testing is advised.

Authors+Show Affiliations

Department of Minimally Invasive Surgery, Legacy Health System, 1040 N.W. 22nd St., Suite 560, Portland, OR 97210, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15135673

Citation

Khajanchee, Yashodhan S., et al. "Outcomes of Antireflux Surgery in Patients With Normal Preoperative 24-hour pH Test Results." American Journal of Surgery, vol. 187, no. 5, 2004, pp. 599-603.
Khajanchee YS, Hong D, Hansen PD, et al. Outcomes of antireflux surgery in patients with normal preoperative 24-hour pH test results. Am J Surg. 2004;187(5):599-603.
Khajanchee, Y. S., Hong, D., Hansen, P. D., & Swanström, L. L. (2004). Outcomes of antireflux surgery in patients with normal preoperative 24-hour pH test results. American Journal of Surgery, 187(5), pp. 599-603.
Khajanchee YS, et al. Outcomes of Antireflux Surgery in Patients With Normal Preoperative 24-hour pH Test Results. Am J Surg. 2004;187(5):599-603. PubMed PMID: 15135673.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcomes of antireflux surgery in patients with normal preoperative 24-hour pH test results. AU - Khajanchee,Yashodhan S, AU - Hong,Dennis, AU - Hansen,Paul D, AU - Swanström,Lee L, PY - 2003/12/11/received PY - 2004/01/19/revised PY - 2004/5/12/pubmed PY - 2004/6/21/medline PY - 2004/5/12/entrez SP - 599 EP - 603 JF - American journal of surgery JO - Am. J. Surg. VL - 187 IS - 5 N2 - OBJECTIVE: Preoperative 24-hour pH testing is controversial in surgical patients who have symptomatic gastroesophageal reflux disease (GERD) and endoscopic evidence of esophagitis. The objective of this study was to compare the clinical outcomes of Nissen fundoplication for symptomatic reflux between patients with normal and abnormal preoperative pH testing. METHODS: Patients were selected from a prospective database of patients who underwent laparoscopic esophageal procedures between January 1997 and December 2001 at our institution. Only patients having typical symptoms of GERD (heartburn and/or reflux), preoperative pH testing, manometry, and endoscopy and who had at least 6 months of post-operative follow-up were included in the study. Fifteen patients had normal preoperative DeMeester scores (DMS) (median 11.4, range 3.3 to 14.7). These were compared with 208 consecutive patients having abnormal preoperative DMS (median 49.6, range 15.2 to 250). Logistic regression modeling was performed to identify variables significant for poor outcome. Differences between means were tested using appropriate parametric or nonparametric tests. RESULTS: There were no statistically significant differences in demographics, preoperative symptom score (mean 2.9 +/- 1.1 vs. 3.1 +/- 0.68, P = 0.30), or preoperative grade of esophagitis (P = 0.37) between the 2 groups. After a median follow-up of 8.8 months (range 6 to 36), 6 (40%) of the patients having normal preoperative DMS and 17 (8.1%) of the patients having abnormal preoperative DMS continued to have typical GERD symptoms (P <0.01, B error = 0.02). The most significant factor for poor outcome in the regression model was normal preoperative pH (odds ratio 9.02, P <0.01). CONCLUSIONS: Symptomatic GERD patients with normal preoperative 24-hour pH test results have significantly worse subjective outcomes after Nissen fundoplication compared with patients having abnormal preoperative pH test results. To minimize poor symptomatic outcomes after antireflux surgery, a policy of routine preoperative pH testing is advised. SN - 0002-9610 UR - https://www.unboundmedicine.com/medline/citation/15135673/Outcomes_of_antireflux_surgery_in_patients_with_normal_preoperative_24_hour_pH_test_results_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002961004000273 DB - PRIME DP - Unbound Medicine ER -