Characterization of long-term outcomes after Toupet fundoplication: symptoms, medication use, and health status.
OBJECTIVE
Fundoplication is increasingly used for the treatment of gastroesophageal reflux disease (GERD). Few studies have tracked patient outcomes of the Toupet method for more than 1 year. Further clinical, physiologic, and patient-based outcome measures have not been well characterized for this method. The current study conducts a long-term, comprehensive outcome evaluation in patients receiving Toupet fundoplication.


METHODS
Fifty-five patients who had previously undergone fundoplication were examined. In a subset of 24 patients, esophagogastroduodenoscopy was used to assess the severity of reflux esophagitis. Manometry and ambulatory pH monitoring also were performed.


RESULTS
Patients were studied 2.9 (+/- 0.7) years after surgery. Sixty-seven percent of the sample reported heartburn, 51% reported postoperative bloating, 33% reported regurgitation, and 20% reported dysphagia. Thirty-three percent reported the use of prescription medications for GERD-related symptoms. Health status was diminished relative to population norms. Degree of GERD severity was associated with symptom reports and medication use.


CONCLUSIONS
Although fundoplication is thought to be a curative procedure, the current findings suggest that many patients take symptomatic therapies and report symptoms and diminished health status up to 2 years after the procedure. These outcomes are associated with physiologic findings. Thus, these findings suggest that symptom-free status and absence of medication use cannot be assumed for all patients after Toupet fundoplication.
Klapow
Joshua C
JC
Department of Psychology, University of Alabama at Birmingham, 330 Ryals Public Health Building, Birmingham, AL 35294-0022, USA. jklapow@uab.edu
Wilcox
C Mel
CM
Mallinger
Alison P
AP
Marks
Robert
R
Heudebert
Gustavo R
GR
Centor
Robert M
RM
Lawrence
William
W
Richter
Joel
J
D016145:Endoscopy, Digestive System; D004942:Esophagitis, Peptic / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods; D005764:Gastroesophageal Reflux / Q000453:epidemiology / Q000601:surgery*; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006304:Health Status; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008365:Manometry; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000453:epidemiology; D015995:Prevalence; D011788:Quality of Life; D013997:Time Factors
D005765:Gastrointestinal Agents