Recurrent symptoms after fundoplication with a negative pH study--recurrent reflux or functional heartburn?
BACKGROUND
A small cohort of patients present after antireflux surgery complaining of recurrent heartburn. Over two thirds of these patients will have a negative 24-h pH study. The aim of our study is to determine whether these patients have an associated functional disorder or abnormal cytokine activity and to examine the reproducibility of pH testing.


METHODS
A prospective analysis was carried out on a cohort of patients who had undergone a fundoplication and postoperative pH testing for recurrent heartburn: group A--patients with recurrent heartburn and a negative 24-h pH study and group B (control group)--patients with recurrent heartburn and a positive pH study. Questionnaires, a blood sample, and repeat pH testing were completed.


RESULTS
Sixty-nine patients were identified. Group A's depression score (8.6 +/- 4.1) was significantly higher than group B's (5.9 +/- 4.2; P = 0.03). Cytokine levels were similar in both groups. Forty-seven of 49 (96%) patients who underwent repeat pH testing had a negative study. Symptom-reflux correlation was highly significant (P < 0.001).


CONCLUSIONS
Some patients with recurrent heartburn and a negative pH study have associated functional or psychiatric comorbidities such as depression. Reproducibility of 24-h pH testing in these patients is excellent.
Thompson
Sarah K
SK
Discipline of Surgery, University of Adelaide, Adelaide, South Australia, Australia. sarah.thompson@adelaide.edu.au
Cai
Wang
W
Jamieson
Glyn G
GG
Zhang
Alison Y
AY
Myers
Jennifer C
JC
Parr
Zoe E
ZE
Watson
David I
DI
Persson
Jenny
J
Holtmann
Gerald
G
Devitt
Peter G
PG
D050782:Esophageal pH Monitoring; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000378:metabolism / Q000601:surgery*; D006356:Heartburn / Q000378:metabolism / Q000601:surgery*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors