Isolated upright gastroesophageal reflux is not a contraindication for antireflux surgery.
BACKGROUND
Patients with gastroesophageal reflux disease who reflux only in the upright position are thought to have a less severe abnormality. Controversy exists over whether these patients should be considered candidates for antireflux surgery.


METHODS
A total of 224 consecutive patients with increased esophageal acid exposure on 24-hour pH monitoring were classified as having upright (n = 54), supine (n = 72), or bipositional (n = 98) reflux and were evaluated by manometry and endoscopy. Of these, 116 patients had a laparoscopic Nissen fundoplication. Their clinical outcome at a median of 12 months (range 4 to 44 months) was compared.


RESULTS
Patients with upright reflux had a lower prevalence of a structurally defective lower esophageal sphincter, fewer hiatal hernias, and less esophageal injury when compared to those with bipositional reflux (p < 0.005). Excellent (asymptomatic) or good outcome (minor symptoms not requiring acid suppression therapy) was achieved in 86% of the patients with upright reflux, 90% of those with supine reflux, and 89% of those with bipositional reflux.


CONCLUSIONS
Patients with upright reflux have less complicated, earlier disease and have results equivalent to those patients with supine and bipositional reflux after antireflux surgery.
Fein
M
M
University of Southern California School of Medicine, Department of Surgery, Los Angeles 90033-4612, USA.
Hagen
J A
JA
Ritter
M P
MP
DeMeester
T R
TR
De Vos
M
M
Bremner
C G
CG
Peters
J H
JH
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000075202:Contraindications; D017558:Elective Surgical Procedures; D004724:Endoscopy; D004943:Esophagogastric Junction / Q000503:physiopathology; D005260:Female; D005764:Gastroesophageal Reflux / Q000503:physiopathology* / Q000601:surgery*; D013502:General Surgery; D006551:Hernia, Hiatal / Q000453:epidemiology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D010535:Laparoscopy; D008297:Male; D008365:Manometry; D008875:Middle Aged; D008991:Monitoring, Physiologic; D009119:Muscle Contraction; D017063:Outcome Assessment, Health Care; D011187:Posture; D016683:Supine Position