title: Characterization of long-term outcomes after Toupet fundoplication: symptoms, medication use, and health status.
abstract: 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.
authors.affiliation: Department of Psychology, University of Alabama at Birmingham, 330 Ryals Public Health Building, Birmingham, AL 35294-0022, USA. jklapow@uab.edu
authors.forename: Joshua C
authors.initials: JC
authors.lastname: Klapow
authors.forename: C Mel
authors.initials: CM
authors.lastname: Wilcox
authors.forename: Alison P
authors.initials: AP
authors.lastname: Mallinger
authors.forename: Robert
authors.initials: R
authors.lastname: Marks
authors.forename: Gustavo R
authors.initials: GR
authors.lastname: Heudebert
authors.forename: Robert M
authors.initials: RM
authors.lastname: Centor
authors.forename: William
authors.initials: W
authors.lastname: Lawrence
authors.forename: Joel
authors.initials: J
authors.lastname: Richter
mesh_terms: 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
chemical_list: D005765:Gastrointestinal Agents