Traditional reflux parameters and not impedance monitoring predict outcome after fundoplication in extraesophageal reflux.
OBJECTIVE
Fundoplication is considered in patients with refractory extraesophageal reflux symptoms. However, postoperative symptom resolution is inconsistent. This analysis investigates which presenting symptoms and preoperative objective parameters predict postoperative symptom improvement.


METHODS
Retrospective cohort study.


METHODS
A total of 237 patients referred for extraesophageal reflux symptoms refractory to medical therapy underwent esophageal function testing. Fundoplication was performed in 27 patients with objective evidence of gastroesophageal reflux disease. Symptomatic improvement was assessed at postoperative intervals. Logistic regression determined which symptoms and objective parameters predicted improvement of the presenting extraesophageal reflux symptom.


RESULTS
Overall, 59% of patients reported at least partial improvement of their presenting extraesophageal symptom after fundoplication. Predictors of symptomatic improvement were the presence of heartburn with or without regurgitation concomitant to their primary presenting symptom (odds ratio [OR], 6.6; 95% confidence interval [CI], 0.97-44.9; P = .05) and pH < 4 more than 12% of a 24-hour period (OR, 10.5; 95% CI, 1.36-81.1; P = .02). Probability of postoperative extraesophageal reflux symptom improvement was 90% if both conditions were present.


CONCLUSIONS
Both heartburn with or without regurgitation and esophageal pH < 4 more than 12% of a 24-hour period predicted postfundoplication resolution of the presenting extraesophageal reflux symptom.
Vanderbilt Voice Center, Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN 37232-8783, USA. david.o.francis@vanderbilt.edu
David O
DO
Francis
Marion
M
Goutte
James C
JC
Slaughter
C Gaelyn
CG
Garrett
David
D
Hagaman
Michael D
MD
Holzman
Michael F
MF
Vaezi
D000368:Aged; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D017097:Electric Impedance; D016145:Endoscopy, Digestive System; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D016015:Logistic Models; D008297:Male; D008365:Manometry; D008875:Middle Aged; D018670:Monitoring, Ambulatory / Q000295:instrumentation*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D016896:Treatment Outcome