Effect of Laparoscopic fundoplication on gastroesophageal reflux disease-induced respiratory symptoms |
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Authors: | Marco G Patti MD Massimo Arcerito MD Andrea Tamburini MD Urs Diener MD Carlo V Feo MD Bassem Safadi MD Piero Fisicbella MD Lawrence W Way MD |
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Institution: | (1) Department of Surgery, University of California, San Francisco, San Francisco, Calif.;(2) Department of Surgery, University of California, San Francisco, 533 Parnassus Ave., Room U-122, 94143-0788 San Francisco, CA |
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Abstract: | Laparoscopic fundoplication controls heartburn and regurgitation, but the effects on the respiratory symptoms of gastroesophageal
reflux disease (GERD) are unclear. Confusion stems from difficulty preoperatively in determining whether cough or wheezing
is actually caused by reflux when reflux is found on pH monitoring. To date, there is no proven way to pinpoint a cause-and-effect
relationship. The goals of this study were to assess the following: (1) the value of pH monitoring in establishing a correlation
between respiratory symptoms and reflux; (2) the predictive value of pH monitoring on the results of surgical treatment; and
(3) the outcome of laparoscopic fundoplication on GERD-induced respiratory symptoms. Between October 1992 and October 1998,
a total of 340 patients underwent laparoscopic fundoplication for GERD. From the clinical findings alone, respiratory symptoms
were thought possibly to be caused by GERD in 39 patients (11 %). These 39 patients had been symptomatic for an average of
134 months. They were all taking H-blocking agents (21 %) or proton pump inhibitors (79%). Seven patients (18%) were also
being treated with bronchodilators, alone (3 patients) or in combination with prednisonc (4 patients). Median length of postoperative
follow-up was 28 months. In 23 patients (59%) a temporal correlation was found during 24-hour pH monitoring between respiratory
symptoms and episodes of reflux. Postoperatively heartburn resolved in 91% of patients, regurgitation in 90% of patients,
wheezing in 64% of patients, and cough in 74% of patients. Cough resolved in 19 (83%) of 23 patients in whom a correlation
between cough and reflux was found during pH monitoring, but in only 8 (57%) of 14 of patients when this correlation was absent.
Cough persisted postoperatively in the two patients who did not cough during the study. These data show that pH monitoring
helped to establish a correlation between respiratory symptoms and reflux, and it helped to identify the patients most likely
to benefit from antircflux surgery. Following laparoscopic surgery, respiratory symptoms resolved in 83% of patients when
a temporal correlation between cough and reflux was found on pH monitoring; heartburn and regurgitation resolved in 90%.
Presented at the Fortieth Annual Meeting ot The Society for Surgery of the Alimentary Tract, Orlando, Fla., May 16–19, 1999. |
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Keywords: | Gastroesophageal reflux disease esophageal manometry prolonged pH monitoring respiratory symptoms laparoscopic fundoplication |
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