Respiratory symptoms in patients with gastroesophageal reflux disease following medical therapy and following antireflux surgery.
BACKGROUND
It is not known whether antireflux surgery is more effective than medical therapy to control respiratory symptoms (RS) in gastroesophageal reflux disease (GERD).


METHODS
In 21 GERD patients with RS, reflux was assessed by endoscopy, manometry, and pH monitoring. Patients had proton pump inhibitor therapy and cisapride for 6 months. After GERD relapsed following withdrawal of medical therapy, 7 patients with normal esophageal peristalsis had a laparoscopic Nissen fundoplication and 14 with impaired peristalsis a Toupet fundoplication. Respiratory symptoms were scored prior to treatment, at 6 months following medical therapy, and at 6 months after surgery.


RESULTS
Heartburn and esophagitis were effectively treated by medical and surgical therapy. Only surgery improved regurgitation. Respiratory symptoms improved in 18 patients (85.7%) following surgery and in only 3 patients (14.3%) following medical therapy (P <0.05). Esophageal peristalsis improved following the Toupet fundoplication.


CONCLUSIONS
Medical therapy fails to control reflux since it does not inhibit regurgitation. Surgery controls reflux and improves esophageal peristalsis, which contributes to its superiority over medical therapy in the treatment of RS associated with GERD.
Wetscher
G J
GJ
Second Department of Surgery, University of Innsbruck, Austria.
Glaser
K
K
Hinder
R A
RA
Perdikis
G
G
Klingler
P
P
Bammer
T
T
Wieschemeyer
T
T
Schwab
G
G
Klingler
A
A
Pointner
R
R
D000328:Adult; D000368:Aged; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D020117:Cisapride; D004359:Drug Therapy, Combination; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000627:therapeutic use; D010880:Piperidines / Q000627:therapeutic use; D012140:Respiratory Tract Diseases / Q000209:etiology*
D000897:Anti-Ulcer Agents; D010880:Piperidines; D009853:Omeprazole; D020117:Cisapride