The effect of chronic pain syndromes and psychoemotional disorders on symptomatic and quality-of-life outcomes of antireflux surgery |
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Authors: | Vic Velanovich MD |
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Institution: | (1) Division of General Surgery, K-8, Henry Ford Hospital, 2799 West Grand Blvd., 48202-2689 Detroit, MI |
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Abstract: | Psychoemotional disorders (PED) and chronic pain syndromes (CPS) are common problems. Many patients with these disorders also
suffer from gastroesophageal reflux disease (GERD). It is unclear how PED/CPS affect outcomes of antireflux surgery; therefore,
the purpose of this study was to determine if PED/CPS adversely affects the results of surgical therapy for GERD. All patients
referred for surgical therapy for GERD completed both the GERD-HRQL symptom severity instrument and the SF-36 generic quality-of-life
instrument prior to surgery. To be candidates for surgery, patients must have symptomatic GERD and objective evidence of pathologic
reflux by upper endoscopy, esophageal manometry and 24-hour pH monitoring. Patients underwent either laparoscopic or open
Nissen or Toupet fundopli-cation. Six to 24 months postoperatively, patients were evaluated for satisfaction and quality-of-life.
Ninety-three percent of control patients compared to 25% of PED/CPS patients were satisfied with surgery (P < 0.001). Dissatisfaction
in PED/CPS patients was generally due to persistent or new somatic complaints. Median total GERD-HRQL scores improved for
both groups, although postoperative scores were worse in the PED/CPS group. PED/CPS patients had significantly worse SF-36
scores both preop-eratively and postoperatively compared to control patients. SF-36 scores improved in four of eight domains
in control patients and none in the PED/CPS patients. In conclusion, PED/CPS patients are generally dissatisfied with antireflux
surgery. Although some patients do benefit from surgery, careful patient selection is required.
Presented at the Forty-Third Annual Meeting of The Society for Surgery of the Alimentary Tract, San Francisco, California,
May 19–22, 2002 (poster presentation). |
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Keywords: | Gastroesophageal reflux disease antireflux surgery fibromyalgia anxiety disorder depression |
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