title: The effect of chronic pain syndromes and psychoemotional disorders on symptomatic and quality-of-life outcomes of antireflux surgery.
abstract: Psychoemotional disorders (PED) and chronic pain syndromes (CPS) are common problems. Many patients with these disorders also suffer from gastroesophageal reflux disease (GERD). It is unclear how PED/CPS affect outcomes of antireflux surgery; therefore, the purpose of this study was to determine if PED/CPS adversely affects the results of surgical therapy for GERD. All patients referred for surgical therapy for GERD completed both the GERD-HRQL symptom severity instrument and the SF-36 generic quality-of-life instrument prior to surgery. To be candidates for surgery, patients must have symptomatic GERD and objective evidence of pathologic reflux by upper endoscopy, esophageal manometry and 24-hour pH monitoring. Patients underwent either laparoscopic or open Nissen or Toupet fundoplication. Six to 24 months postoperatively, patients were evaluated for satisfaction and quality-of-life. Ninety-three percent of control patients compared to 25% of PED/CPS patients were satisfied with surgery (P < 0.001). Dissatisfaction in PED/CPS patients was generally due to persistent or new somatic complaints. Median total GERD-HRQL scores improved for both groups, although postoperative scores were worse in the PED/CPS group. PED/CPS patients had significantly worse SF-36 scores both preoperatively and postoperatively compared to control patients. SF-36 scores improved in four of eight domains in control patients and none in the PED/CPS patients. In conclusion, PED/CPS patients are generally dissatisfied with antireflux surgery. Although some patients do benefit from surgery, careful patient selection is required.
authors.affiliation: Division of General Surgery, K-8, Henry Ford Hospital, 2799 West Grand Blvd., 48202-2689, Detroit, MI. vvelano1@hfhs.org.
authors.forename: Vic
authors.initials: V
authors.lastname: Velanovich
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000150:complications; D003866:Depressive Disorder / Q000150:complications; D015673:Fatigue Syndrome, Chronic / Q000150:complications*; D005260:Female; D005356:Fibromyalgia / Q000150:complications*; D005764:Gastroesophageal Reflux / Q000523:psychology / Q000601:surgery*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications*; D008875:Middle Aged; D017060:Patient Satisfaction; D011788:Quality of Life; D012559:Schizophrenia / Q000150:complications; D011795:Surveys and Questionnaires