Document Detail


Changes in GERD symptom scores correlate with improvement in esophageal acid exposure after the Stretta procedure.
MedLine Citation:
PMID:  15156392     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Endoscopic radiofrequency energy delivery (Stretta) is effective for managing gastroesophageal reflux disease (GERD) in selected patients. One criticism, however, is a theory that a mechanism of action is partial desensitization of the esophageal body rather than a reduction in esophageal acid exposure. To resolve this question, this study sought to determine if there is a correlation between the improvement in GERD outcomes and esophageal acid exposure after Stretta. METHODS: Subgroup analyses were performed between "responder" and "nonresponder" groups from the U.S. Stretta open label trial ( n = 118), on the basis of posttreatment responses for GERD health-related quality of life (HRQL) heartburn, satisfaction, and proton pump inhibitor use. Outcomes were analyzed within and between subgroups. Pearson correlation coefficient analysis was performed comparing distal esophageal acid exposure with each of the continuous outcomes (GERD-HRQL, heartburn, satisfaction). RESULTS: Responder subgroups had significant improvements in esophageal acid exposure, whereas nonresponders had no change or less improvement in the same. Changes in GERD-HRQL and heartburn severity were correlated with changes in acid exposure ( r = 0.16, p = 0.12 and r = 0.26, p = 0.01, respectively). Changes in satisfaction were negatively correlated with changes in esophageal acid exposure ( r = 0.23, p = 0.02) because satisfaction, as expected, increased as acid exposure decreased. CONCLUSIONS: Responders had significant improvement in esophageal acid exposure, whereas nonresponders had less or no change. There was a positive correlation between esophageal acid exposure and both GERD-HRQL and heartburn. This evidence suggests that symptomatic improvement after Stretta is attributable to a decrease in esophageal acid exposure and not to desensitization of the esophagus.
Authors:
G Triadafilopoulos
Publication Detail:
Type:  Clinical Trial; Journal Article     Date:  2004-05-27
Journal Detail:
Title:  Surgical endoscopy     Volume:  18     ISSN:  1432-2218     ISO Abbreviation:  Surg Endosc     Publication Date:  2004 Jul 
Date Detail:
Created Date:  2004-07-29     Completed Date:  2005-05-05     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8806653     Medline TA:  Surg Endosc     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  1038-44     Citation Subset:  IM    
Affiliation:
Gastroenterology Section, Veterans Affairs Palo Alto Health Care System, and the Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 3801 Miranda Avenue, Palo Alto, Stanford CA 94304, USA. vagt@stanford.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Anti-Ulcer Agents / therapeutic use
Catheter Ablation*
Combined Modality Therapy
Esophagitis / etiology
Esophagoscopy
Female
Gastric Acidity Determination
Gastric Juice
Gastroesophageal Reflux / drug therapy,  etiology,  surgery*
Hernia, Hiatal / complications
Humans
Hydrogen-Ion Concentration
Male
Middle Aged
Monitoring, Ambulatory
Patient Satisfaction
Proton Pumps / antagonists & inhibitors
Severity of Illness Index
Treatment Outcome
Chemical
Reg. No./Substance:
0/Anti-Ulcer Agents; 0/Proton Pumps

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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