Gastroesophageal reflux, quality of life, and satisfaction in patients with achalasia treated with open cardiomyotomy and partial fundoplication.
BACKGROUND
Cardiomyotomy, often associated with an antireflux technique, is effective in the management of achalasia, although gastroesophageal reflux (GER) may occur after the procedure. Patient-centered measures, ie, health-related quality of life (HRQoL) and satisfaction, should be included in the evaluation of the patients.


METHODS
A study was made of the incidence of GER (symptoms, upper endoscopy and 24-hour pH monitoring), HRQoL (Short Form-36 Health Survey), and satisfaction after open-access cardiomyotomy and 180-degree anterior fundoplication in 28 consecutive patients, with a minimum postoperative follow-up of 12 months.


RESULTS
Mean age was 45 years (range 15 to 80) and 68% were female. In 8 subjects (all with heartburn) GER morbidity was present (4 with esophagitis and 4 with positive pH study), and 6 patients required proton pump inhibitors. Short Form-36 scores after surgery were similar to those found in the general population. Patient satisfaction was high and was more related to the absence of dysphagia than to the presence of GER symptoms.


CONCLUSIONS
Gastroesophageal reflux is relatively frequent after cardiomyotomy and partial fundoplication, although the efficacy of proton pump inhibitor treatment minimizes its clinical significance.
Ponce
Marta
M
Gastroenterology Unit, La Fe University Hospital, Valencia, Spain. jponce@doymanet.es
Ortiz
Vicente
V
Juan
Manuel
M
Garrigues
Vicente
V
Castellanos
Concepción
C
Ponce
Julio
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002299:Cardia / Q000473:pathology / Q000601:surgery; D004931:Esophageal Achalasia / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D004943:Esophagogastric Junction / Q000473:pathology / Q000601:surgery; D005260:Female; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D005773:Gastroscopy; D006801:Humans; D007813:Laparotomy / Q000379:methods; D008297:Male; D008365:Manometry; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications; D011446:Prospective Studies; D011788:Quality of Life; D016896:Treatment Outcome