Document Detail


Recurrent heartburn after laparoscopic fundoplication is not always recurrent reflux.
MedLine Citation:
PMID:  17468924     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: A small cohort of patients present after antireflux surgery complaining of recurrent heartburn. Many of these patients have been empirically recommenced on proton pump inhibitors. OBJECTIVE: The aim of this study was to determine whether patients with symptoms that suggest recurrent reflux had objective evidence of reflux, and to determine predictors of recurrent reflux. METHODS: We identified all patients from an existing database who had undergone pH monitoring for "recurrent heartburn" after fundoplication. These patients were then cross-referenced to another database, which recorded the outcomes for patients who had undergone a laparoscopic fundoplication. Patients complaining of dysphagia or other problems without heartburn were excluded from analysis. RESULTS: Seventy-six patients were identified who met the inclusion criteria. Fifty-six (74%) of these had a normal 24-h pH study. Thirty-five patients (63%) with a normal pH study were on medication for heartburn at the time of referral. Three factors were found to be associated with an abnormal 24-h pH study: a partial fundoplication (P = 0.039), onset of symptoms 6 months or more after surgery (P < 0.001), and a good symptom response when antireflux medication was recommenced (P = 0.015). CONCLUSIONS: Not all patients complaining of recurrent heartburn after fundoplication have evidence of abnormal reflux. Objective evidence of abnormal esophageal acid exposure should be confirmed before recommencing antireflux medication.
Authors:
Sarah K Thompson; Glyn G Jamieson; Jennifer C Myers; Kin-Fah Chin; David I Watson; Peter G Devitt
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract     Volume:  11     ISSN:  1091-255X     ISO Abbreviation:  J. Gastrointest. Surg.     Publication Date:  2007 May 
Date Detail:
Created Date:  2007-04-30     Completed Date:  2007-09-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9706084     Medline TA:  J Gastrointest Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  642-7     Citation Subset:  IM    
Affiliation:
Department of Surgery, University of Adelaide, Level 5, Eleanor Harrald Building, Royal Adelaide Hospital, Adelaide, South Australia 5000, Australia. sarah.thompson@adelaide.edu.au
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Antacids / therapeutic use
Cohort Studies
Deglutition Disorders / diagnosis
Esophageal pH Monitoring
Esophagitis / diagnosis
Esophagoscopy
Female
Follow-Up Studies
Forecasting
Fundoplication / adverse effects,  methods*
Gastroesophageal Reflux / diagnosis,  surgery*
H(+)-K(+)-Exchanging ATPase / antagonists & inhibitors
Heartburn / diagnosis,  etiology*
Histamine H2 Antagonists / therapeutic use
Humans
Laparoscopy*
Male
Middle Aged
Prospective Studies
Recurrence
Treatment Outcome
Chemical
Reg. No./Substance:
0/Antacids; 0/Histamine H2 Antagonists; EC 3.6.1.10/H(+)-K(+)-Exchanging ATPase

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


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