Preoperative symptom evaluation and esophageal acid infusion predict response to laparoscopic Nissen fundoplication in gastroesophageal reflux patients who present with cough.
BACKGROUND
Most patients with cough and gastroesophageal reflux disease (GERD) improve on medical treatment with proton pump inhibitors (PPI). Nonresponders may be considered for antireflux surgery, but the selection of patients is difficult.


METHODS
We have performed laparoscopic Nissen fundoplications (LNF) in 677 patients. Of these patients, 81% have undergone 6-month follow-up assessment with 24-h pH testing, esophageal manometry, symptom scores, and quality-of-life scores.


RESULTS
LNF controlled heartburn in 93% and improved cough in 81%. Stepwise multiple regression showed that the preoperative cough score (r = 0.620, p <0.0001) and change in cough on and off PPI (r = 0.296, p = 0.0002) predicted improvement after surgery. A positive result on a randomized acid infusion test was associated with a greater improvement in cough after surgery (p = 0.0243).


CONCLUSIONS
An acid infusion test and assessment of cough on and off PPI may be useful preoperative tools for the selection of patients with cough for LNF.
Allen
C J
CJ
Department of Medicine, St. Joseph's Hospital, McMaster University, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6, Canada. allencj@mcmaster.ca
Anvari
M
M
D003371:Cough / Q000139:chemically induced / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D004311:Double-Blind Method; D004947:Esophagus / Q000187:drug effects*; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000139:chemically induced / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D006356:Heartburn / Q000209:etiology / Q000601:surgery; D006801:Humans; D006851:Hydrochloric Acid / Q000008:administration & dosage; D006863:Hydrogen-Ion Concentration; D007260:Infusion Pumps; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D011788:Quality of Life; D012044:Regression Analysis
D006851:Hydrochloric Acid