title: Outcome of laparoscopic Nissen fundoplication for gastroesophageal reflux disease in non-responders to proton pump inhibitors.
abstract: BACKGROUND
  Gastroesophageal reflux disease (GERD) is a common public health problem. Medical treatment remains the first line of treatment of GERD. Failure of medical treatment may occur in up to 45% of GERD patients. This study aims to evaluate the outcome of laparoscopic Nissen fundoplication (LNF) as a means of antireflux surgery in patients with poor response to anti-reflux medication.
  
  
  METHODS
  This is a prospective study of patients who underwent LNF in the period between January 2000 and December 2010 in the Gastrointestinal Surgical Center, Mansoura University, Egypt. Patients were assessed preoperatively and postoperatively, after 1 year, by clinical examination, esophagogastroscope, barium esophagography, esophageal manometry and 24-h pH monitoring. Patient satisfaction after surgery was also graded through a questionnaire.
  
  
  RESULTS
  The study population was 370 patients. 296 patients were good responders to proton pump inhibitors (PPI) while 74 patients were PPI non-responders. Preoperatively, atypical reflux symptoms were significantly more in PPI non-responders (P = 0.006). On follow-up, PPI responders significantly reported relief of heartburn (P = 0.01) and regurgitation (P = 0.04). Patient satisfaction was more in PPI responders (P = 0.04). Both groups were comparable regarding anatomical and functional assessment. Integrity of the wrap was higher in PPI responders (P = 0.04).
  
  
  CONCLUSIONS
  PPI non-responders should not be precluded from LNF. Thorough assessment is mandatory to confirm GERD diagnosis. A substantial proportion of PPI failures show good response to LNF but significantly than clinical response in PPI responders. Increased likelihood of poor outcome after surgery should be discussed with the patient.
authors.affiliation: Mansoura University Hospital, Mansoura, Egypt.
authors.forename: Emad
authors.initials: E
authors.lastname: Hamdy
authors.forename: Ayman
authors.initials: A
authors.lastname: El Nakeeb
authors.forename: Hosam
authors.initials: H
authors.lastname: Hamed
authors.forename: Mohamed
authors.initials: M
authors.lastname: El Hemaly
authors.forename: Nabil Gad
authors.initials: NG
authors.lastname: ElHak
mesh_terms: D000328:Adult; D003680:Deglutition Disorders / Q000188:drug therapy / Q000209:etiology; D004351:Drug Resistance; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000150:complications / Q000188:drug therapy* / Q000601:surgery*; D006356:Heartburn / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D010535:Laparoscopy; D057045:Laryngopharyngeal Reflux / Q000188:drug therapy / Q000209:etiology; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D054328:Proton Pump Inhibitors