Document Detail

Long-term outcome of Nissen fundoplication in non-erosive and erosive gastro-oesophageal reflux disease.
MedLine Citation:
PMID:  20473997     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Non-erosive (NERD) and erosive (ERD) gastro-oesophageal reflux disease (GORD) show similar severity of symptoms and impact on quality of life (QoL). Prospective data on long-term outcomes of antireflux surgery in NERD are lacking. METHODS: Subjective and objective 5-year outcomes of Nissen fundoplication were compared in 96 patients with NERD and 117 with ERD, operated on for proton-pump inhibitor (PPI)-refractory GORD. RESULTS: Preoperative and postoperative QoL, PPI use, acid exposure time, symptom-reflux correlation, lower oesophageal sphincter (LOS) pressure and reoperation rates were similar in the two groups. At 5 years, relief of reflux symptoms was similar (NERD 89 per cent versus ERD 96 per cent), PPI use showed a similar reduction (82 to 21 per cent versus 81 to 15 per cent respectively; both P < 0.001) and QoL score improved equally (50.3 to 65.2 (P < 0.001) versus 52.0 to 60.7 (P = 0.016)). Five patients with NERD developed erosions after surgery; oesophagitis healed in 87 per cent of patients with ERD. Reduction in total acid exposure time (NERD 12.7 to 2.0 per cent versus ERD 13.8 to 2.9 per cent; both P < 0.001) and increase in LOS pressure (1.3 to 1.8 kPa versus 1.2 to 1.8 kPa; both P < 0.001) were similar. The reintervention rate was comparable (NERD 15 per cent versus ERD 12.8 per cent). CONCLUSION: Patients with PPI-refractory NERD and ERD benefit equally from Nissen fundoplication. The absence of mucosal lesions on endoscopy in patients with proven PPI-refractory reflux disease is not a reason to refrain from antireflux surgery.
J A Broeders; W A Draaisma; A J Bredenoord; A J Smout; I A Broeders; H G Gooszen
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The British journal of surgery     Volume:  97     ISSN:  1365-2168     ISO Abbreviation:  Br J Surg     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-05-17     Completed Date:  2010-06-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372553     Medline TA:  Br J Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  845-52     Citation Subset:  AIM; IM    
Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
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MeSH Terms
Fundoplication / methods*
Gastroesophageal Reflux / physiopathology,  surgery*
Hydrogen-Ion Concentration
Long-Term Care
Middle Aged
Postoperative Care
Prospective Studies
Proton Pump Inhibitors / therapeutic use
Quality of Life
Treatment Outcome
Young Adult
Reg. No./Substance:
0/Proton Pump Inhibitors

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