Symptoms are a poor indicator of reflux status after fundoplication for gastroesophageal reflux disease: role of esophageal functions tests.
BACKGROUND
If a patient develops foregut symptoms after a fundoplication, it is assumed that the operation has failed, and acid-reducing medications are often prescribed. Esophageal function tests (manometry and pH monitoring) are seldom performed early in the management of these patients.


OBJECTIVE
In patients who are symptomatic after fundoplication for gastroesophageal reflux disease, a symptom-based diagnosis is not accurate, and esophageal function tests should be performed routinely before starting acid-reducing medications.


METHODS
Prospective study.


METHODS
University hospital.


METHODS
One hundred twenty-four patients who developed foregut symptoms after laparoscopic fundoplication (average, 17 months postoperatively) underwent esophageal manometry and pH monitoring. Sixty-two patients (50%) were taking acid-reducing medications.


METHODS
Postoperative symptoms, use of antireflux medications, grade of esophagitis, esophageal motility, and DeMeester scores.


RESULTS
Seventy-six (61%) of the 124 patients had normal esophageal acid exposure, while the acid exposure was abnormal in 48 patients (39%). Only 20 (32%) of the 62 patients who were taking acid-reducing medications had reflux postoperatively. Regurgitation was the only symptom that predicted abnormal reflux.


CONCLUSIONS
These results show that (1) symptoms were due to reflux in 39% of patients only; (2) with the exception of regurgitation, symptoms were an unreliable index of the presence of reflux; and (3) 68% of patients who were taking acid-reducing medications postoperatively had a normal reflux status. Esophageal function tests should be performed early in the evaluation of patients after fundoplication to avoid improper and costly medical therapy.
Galvani
Carlos
C
Department of Surgery and Swallowing Center, University of California-San Francisco, San Francisco 94143-0788, USA.
Fisichella
Piero M
PM
Gorodner
Maria V
MV
Perretta
Silvana
S
Patti
Marco G
MG
D000328:Adult; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008365:Manometry; D008875:Middle Aged; D008991:Monitoring, Physiologic; D011446:Prospective Studies; D012008:Recurrence