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Neurogastroenterol Motil. 2016 Jan;28(1):146-52. doi: 10.1111/nmo.12715. Epub 2015 Nov 3.

24-hour pH-impedance monitoring on therapy to select patients with refractory reflux symptoms for antireflux surgery. A single center retrospective study.

Author information

1
Gastroenterology and Hepatology Department, Hôpital Saint André, Centre Hospitalier Universitaire de Bordeaux and Université de Bordeaux, Bordeaux, France.
2
Digestive Surgery Department, Hôpital Haut Lévêque, Centre Hospitalier Universitaire de Bordeaux and Université de Bordeaux, Bordeaux, France.

Abstract

BACKGROUND:

Treatment of gastro-esophageal reflux refractory symptoms is challenging. This monocenter retrospective study assessed the value of preoperative pH-impedance monitoring 'on' therapy to predict functional outcome after laparoscopic fundoplication in patients with refractory reflux symptoms.

METHODS:

Patients with a preoperative pH-impedance monitoring 'on' proton pump inhibitors (PPIs) twice daily were assessed at least 6 months after a laparoscopic fundoplication for refractory reflux symptoms. Failure of fundoplication was defined by a Visick score > 2. Postoperative symptoms were assessed by the reflux disease questionnaire (RDQ). The pH-impedance parameters analyzed were the number of reflux events (total, acid, non-acid), esophageal acid exposure time, esophageal bolus exposure time, and symptom-reflux association defined by symptom index (SI) >50% and symptom association probability (SAP) >95%.

KEY RESULTS:

Thirty-three patients (18 female patients, median age 46 years) were assessed after a mean follow-up of 41.3 (range 7-102.2) months. Seven (21.2%) patients were considered as failures. Compared to patients with favorable outcome, these patients were more often 'on' PPI therapy (86% vs 23%, p < 0.05) and had higher RDQ scores in each domain: heartburn (p < 0.05), regurgitation (p < 0.05) and dyspepsia (p < 0.05). A positive SAP was the only pH-impedance parameter statistically associated with successful postoperative outcome (p = 0.004).

CONCLUSIONS & INFERENCES:

On therapy, a preoperative positive symptom association probability is the only pH-impedance parameter associated with favorable outcome after laparoscopic fundoplication for refractory reflux symptoms. These results should be confirmed by prospective studies.

KEYWORDS:

fundoplication; gastro-esophageal reflux; pH-impedance monitoring

PMID:
26526815
DOI:
10.1111/nmo.12715
[Indexed for MEDLINE]

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