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Br J Surg. 2011 Feb;98(2):247-54. doi: 10.1002/bjs.7296.

Impact of symptom-reflux association analysis on long-term outcome after Nissen fundoplication.

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Department of Surgery, Gastrointestinal Research Unit of the University Medical Center Utrecht, Utrecht, The Netherlands.



A positive symptom association probability (SAP) is regarded as an important selection criterion for antireflux surgery by many physicians. However, no data corroborate the relationship between symptom-reflux association and outcome, nor is it clear what impact a negative SAP has on the outcome of antireflux surgery in patients with abnormal oesophageal acid exposure. This study compared long-term outcomes of Nissen fundoplication in patients with a negative versus positive SAP.


Five-year outcome of Nissen fundoplication in patients with proton-pump inhibitor (PPI)-refractory reflux and pathological acid exposure was compared between those with (SAP+, 109) and without (SAP-, 29 patients) a positive symptom association. Symptoms, quality of life (QoL), PPI use, endoscopic findings, manometry and acid exposure were evaluated.


At 5 years' follow-up, relief of reflux symptoms (95 versus 87 per cent), reduction in PPI use (80 to 25 per cent versus 85 to 14 per cent; P < 0·050) and improvement in QoL were similar in the SAP- and SAP+ groups. Reduction in acid exposure time (13·4 to 1·6 per cent versus 11·1 to 0·2 per cent of total time; P < 0·010), improvement in oesophagitis (44 to 6 per cent versus 61 to 13 per cent; P < 0·050) and increase in lower oesophageal sphincter pressure were also comparable.


The subjective and objective outcomes of fundoplication in patients with pathological acid exposure are comparable among those with a positive and negative SAP. Patients with pathological acid exposure and a negative SAP can also benefit from antireflux surgery.

[Indexed for MEDLINE]

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