Background: Gastroesophageal reflux disease (GERD)-induced pulmonary symptoms (PS) can be difficult to control. The effectiveness of laparoscopic fundoplication (LF) in controlling PS among patients with medically recalcitrant GERD is poorly documented. We evaluated our results in controlling important PS in patients with GERD undergoing LF.
Methods: Seventy-four patients (28 men, 46 women) were identified with clinically important PS from a prospective cohort of 155 patients undergoing elective LF for recalcitrant GERD. Median age was 52.5 years (range, 29-84 years). Sixty-seven (91%) patients were taking proton pump inhibitors at the time of operation. Quality of life by using the SF36 physical (PCS) and mental (MCS) component summary scores (normal, 50) and heartburn severity by using the health-related quality of life (HRQOL) (best score, 0; worst score, 45) were measured.
Results: All 74 patients with PS survived operation, and minor morbidity occurred in 5 (7%) patients. Median hospital stay was 2 days (range, 1-6 days), and return to normal activity was seen at 2.2 weeks (range, 1-8 weeks). Median follow-up was 12 months. PS were improved significantly (P < .01) for hoarseness (62% to 17.6%), bronchospasm (60% to 9.5%), and aspiration (22% to 1.4%). Before LF, 11 (14.9%) patients required bronchodilators or oral steroids. Postoperatively such therapy was required in only 3 (4.2%) patients (P = .019), with no patient requiring oral steroids. Patients with poorer control of their GERD on the basis of high HRQOL scores had significantly more PS after operation.
Conclusions: A significant number of patients with medically recalcitrant GERD (46% from our prospective database) have important PS. LF can improve PS, decrease requirement for pulmonary medications, as well as improve typical reflux symptoms and quality of life.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.surg.2005.07.013 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Pharmacological and Biological Relevance in the Medical Treatment of Laryngopharyngeal Reflux: A State-of-the-Art Review.
J Voice
November 2024
Department of Anatomy, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium; Division of Laryngology and Broncho-Esophagology, Department of Otolaryngology-Head Neck Surgery, EpiCURA Hospital, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium; Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, Paris Saclay University, Phonetics and Phonology Laboratory (UMR 7018 CNRS, Université Sorbonne Nouvelle/Paris 3), Paris, France; Department of Otorhinolaryngology and Head and Neck Surgery, CHU Saint-Pierre, Brussels, Belgium. Electronic address:
The laryngopharyngeal reflux disease (LPRD) treatment remains controversial due to the poor effectiveness of proton pump inhibitors (PPIs). In this paper, the author reviewed the current primary treatments used in clinical studies for managing LPRD and discussed the pharmacological, biological, and physiological properties of medication for providing clinical relevance for otolaryngological practice. A comprehensive review of the PubMed, Cochrane Library, and Scopus literature was conducted to document and analyze the medical treatments of LPRD in the largest case series published in the past 20 years.
View Article and Find Full Text PDFAdvances in laryngopharyngeal reflux: Etiology, diagnosis, and management.
Ann N Y Acad Sci
November 2024
Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Article Synopsis
- * Diagnosis and treatment of LPR can be challenging due to its diverse subtypes, but advanced monitoring techniques and specific therapies are available to tailor management plans.
- * Ongoing research into LPR aims to improve understanding and develop new diagnostic and treatment strategies, including the use of pepsin inhibitors and comprehensive approaches to address laryngeal hypersensitivity.
Global Transcriptomic Analysis of Topical Sodium Alginate Protection against Peptic Damage in an In Vitro Model of Treatment-Resistant Gastroesophageal Reflux Disease.
Int J Mol Sci
October 2024
Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
Breakthrough symptoms are thought to occur in roughly half of all gastroesophageal reflux disease (GERD) patients despite maximal acid suppression (proton pump inhibitor, PPI) therapy. Topical alginates have recently been shown to enhance mucosal defense against acid-pepsin insult during GERD. We aimed to examine potential alginate protection of transcriptomic changes in a cell culture model of PPI-recalcitrant GERD.
View Article and Find Full Text PDFNational trends in utilization and safety of gastric bypass, sleeve gastrectomy and conversion surgery in patients with GERD.
Surg Endosc
March 2024
Department of Surgery, Brigham and Women's Hospital, Boston, MA, 02115, USA.
Background: While some studies have reported improvement in gastro-esophageal reflux disease (GERD) symptoms after sleeve gastrectomy (SG), others have reported higher incidence of de-novo GERD, worsening of prior GERD symptoms and erosive esophagitis post SG. Furthermore, GERD unresponsive to medical management is one of the most common indications for conversion of SG to Roux-en-Y gastric bypass (RYGB). Real-world data on safety of primary SG, primary RYGB and SG to RYGB conversion for obese patients with GERD would be helpful for informing surgeons and patient procedure selection.
View Article and Find Full Text PDFThe Protease Inhibitor Amprenavir Protects against Pepsin-Induced Esophageal Epithelial Barrier Disruption and Cancer-Associated Changes.
Int J Mol Sci
April 2023
Department of Otolaryngology and Communication Science, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
Gastroesophageal reflux disease (GERD) significantly impacts patient quality of life and is a major risk factor for the development of Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC). Proton pump inhibitors (PPIs) are the standard-of-care for GERD and are among the most prescribed drugs in the world, but do not protect against nonacid components of reflux such as pepsin, or prevent reflux-associated carcinogenesis. We recently identified an HIV protease inhibitor amprenavir that inhibits pepsin and demonstrated the antireflux therapeutic potential of its prodrug fosamprenavir in a mouse model of laryngopharyngeal reflux.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!