Nonsurgical factors affecting symptomatic outcomes of antireflux surgery.
A small number of patients will have persistent or new symptoms after antireflux surgery for gastroesophageal reflux disease (GERD). Most of these symptoms are due to recurrent reflux or some complication or side-effect of the operation. However, a few of these patients will be symptomatic without objective findings to explain these symptoms. The purpose of this review is to highlight potential non-surgical factors that may proceed to a poor symptomatic outcome after antireflux surgery. These factors include underlying esophageal pathophysiology, issues related to chronic pain and pain perception, personality and psychoemotional disorders, functional esophageal and/or bowel disorders, and the nocebo phenomenon. Awareness of these other causes can lead to more appropriate treatments.
Velanovich
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Division of General Surgery, Henry Ford Hospital, Detroit, Michigan 48202-2689, USA. vvelano1@hfhs.org
D001008:Anxiety Disorders / Q000150:complications; D003469:Culture; D064420:Drug-Related Side Effects and Adverse Reactions; D004935:Esophageal Diseases / Q000503:physiopathology; D005764:Gastroesophageal Reflux / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007410:Intestinal Diseases / Q000503:physiopathology; D001523:Mental Disorders / Q000150:complications; D010149:Postoperative Pain / Q000209:etiology / Q000503:physiopathology / Q000523:psychology; D011183:Postoperative Complications / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome