title: Surgical cure of primary hyperparathyroidism ameliorates gastroesophageal reflux symptoms.
abstract: OBJECTIVE
  Gastroesophageal reflux disease (GERD) symptoms are commonly reported in primary hyperparathyroidism (pHPT). Although a calcium-mediated cause-and-effect relationship has been suggested, it remains unknown if parathyroidectomy improves GERD symptoms.
  
  
  METHODS
  Over a 22-month period, 1,175 (39%) of 3,000 consecutive adult patients with pHPT and symptomatic GERD (on prescription reflux medications daily for ≥2 years) undergoing parathyroidectomy were entered into a prospective study. Standardized Frequency Scale for Symptoms of GERD (FSSG) questionnaire was used to assess symptoms before, 1 and 2 years after parathyroidectomy.
  
  
  RESULTS
  Daily prescription medication was used by 81%, while 19% used daily non-prescription drugs, both for a mean of 2.9 ± 0.7 years. GERD symptoms improved (26%) or resolved completely (36%) in 62% of patients (p < 0.0001 vs. preoperative baseline) 1 year after parathyroidectomy. Prescription medications for GERD decreased from 81% of enrolled patients to 26% (p < 0.0001) 12 months postoperatively, with 39% having complete symptom relief and taking no medications (p < 0.0001). Daily use of prescription GERD medications decreased to occasional over-the-counter drug use in 35% after parathyroidectomy (p < 0.0001). Mean FSSG scores decreased significantly postoperatively (pre-op: 18.0 ± 8.0 vs. post-op: 10.0 ± 5.0; p < 0.0001), with significant improvements in all 12 FSSG categories, including motility (pre-op: 7.3 ± 3.0 vs. post-op: 4.4 ± 3.0; p < 0.0001) and acid reflux symptoms (pre-op: 10.8 ± 5.0 vs. post-op: 5.9 ± 4.0; p < 0.0001). Symptomatic improvements were durable 2 years after parathyroidectomy.
  
  
  CONCLUSIONS
  Symptomatic GERD is common in pHPT. Parathyroidectomy provides significant, durable relief of both motility and acid reflux symptoms allowing discontinuation of prescription drug use for GERD in most (74%) patients providing yet another indication for parathyroidectomy in pHPT.
authors.affiliation: Norman Parathyroid Center, Tampa, FL, USA, jnorman@parathyroid.com.
authors.forename: James
authors.initials: J
authors.lastname: Norman
authors.forename: Douglas
authors.initials: D
authors.lastname: Politz
authors.forename: Jose
authors.initials: J
authors.lastname: Lopez
authors.forename: Deva
authors.initials: D
authors.lastname: Boone
authors.forename: Alexander
authors.initials: A
authors.lastname: Stojadinovic
mesh_terms: D000368:Aged; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy; D011184:Postoperative Period; D011446:Prospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires