Laparoscopic antireflux surgery in gastro-oesophageal reflux disease patients with concomitant anxiety disorders.

Background: Several psychological factors are known to affect the subjective outcome, such as quality of life, after laparoscopic antireflux surgery.

Aim: To evaluate: a. outcome of laparoscopic antireflux surgery in gastro-oesophageal reflux disease patients with concomitant anxiety disorders, b. potential effects of laparoscopic antireflux surgery on psychiatric comorbidities.

Patients And Methods: Out of more than 550 patients who underwent laparoscopic antireflux surgery, 21 suffered from additional anxiety disorders. Outcome assessments included traditional data, evaluation of symptoms and side-effects, and quality of life. These data were evaluated before laparoscopic antireflux surgery and 6 weeks, 3 months and 1 year after surgery,

Results: Post-operative lower oesophageal sphincter pressure and DeMeester score were normal in all patients. Subjective severity of anxiety disorders remained unchanged in 13 patients 1 year after surgery. One patient suffered from severe dysphagia and required single dilatation. In this patient, severity and frequency of panic attacks increased for approximately 6 months after laparoscopic antireflux surgery. In 7 patients, total relief of panic symptoms was reported within 3 months post-operatively. Severity of most gastro-oesophageal reflux disease-related symptoms decreased significantly after laparoscopic antireflux surgery, but severity of some symptoms remained stable in patients with continuing anxiety disorders. In all patients, Gastrointestinal Quality of Life Index increased significantly. This improvement was less marked in patients with continuing anxiety disorders. Patients presenting total relief of panic symptoms showed an outcome comparable to normal data.

Conclusions: Data obtained suggest that patients with concomitant anxiety disorders should not generally be excluded from laparoscopic antireflux surgery but should be selected more carefully. In these patients, surgery significantly improves quality of life and eliminates gastro-oesophageal reflux disease-related symptoms. Some patients demonstrated less symptomatic relief. In contrast, laparoscopic antireflux surgery was able to eliminate panic disorders in one third of our patients.