Improvement of gastroesophageal reflux disease in Japanese patients with spinal kyphotic deformity who underwent surgical spinal correction.
OBJECTIVE
Spinal kyphotic deformity occasionally results in gastroesophageal reflux disease (GERD). The effects of acid reflux on the esophagus in kyphotic patients are unclear, however, and it is unknown whether acid reflux, endoscopic GERD, and reflux-related symptoms improve following surgical spinal correction in these patients. Herein, we investigated the characteristics of GERD in kyphotic patients and the improvement in GERD following surgical correction.


METHODS
In 48 patients with severe kyphotic deformity scheduled for surgical spinal correction, we conducted esophagogastroduodenoscopy, 24-h pH monitoring and three questionnaire surveys, including the frequency scale for the symptoms of GERD (FSSG). We repeated these measurements after surgical correction and compared pre- and post-surgery values.


RESULTS
Of 48 patients, 70.8% [95% CI: 55.9-83.0%, 34/48] had endoscopically evaluated esophageal mucosal injury. Regarding pH before surgery, 64.9% (CI: 47.5-79.8%, 24/37) had abnormal acid reflux (intraesophageal pH < 4 more than 5% of the time). FSSG score was significantly associated with the severity of GERD, and the positive rate was 52.6% (CI: 35.8-69.0%, 20/38). Following surgical correction, esophageal mucosal injury improved endoscopically in 90% of patients, and median total FSSG score significantly decreased from 8 (0-30) to 5 (0-19) (P = 0.005). Regarding pH after surgery, prevalence of abnormal acid reflux decreased from 66.7% (95% CI: 41.0-86.7%) to 33.3% (95% CI: 13.3-59.0%) (P = 0.045).


CONCLUSIONS
Surgical spinal correction in kyphosis patients improves not only kyphotic deformity-related disorders but also esophageal mucosal injury, abnormal acid reflux, and reflux-related symptoms.
First Department of Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan.|Division of Digestive Endoscopy, Shiga University of Medical Science Hospital, Shiga, Japan.
Mitsushige
M
Sugimoto
Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan.
Tomohiko
T
Hasegawa
First Department of Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan.
Masafumi
M
Nishino
First Department of Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan.
Shu
S
Sahara
First Department of Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan.
Takahiro
T
Uotani
First Department of Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan.
Hitomi
H
Ichikawa
First Department of Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan.
Takuma
T
Kagami
First Department of Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan.
Ken
K
Sugimoto
Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan.
Yu
Y
Yamato
Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan.
Daisuke
D
Togawa
Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan.
Sho
S
Kobayashi
Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan.
Hironobu
H
Hoshino
Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan.
Yukihiro
Y
Matsuyama
Center for Clinical Research, Hamamatsu University School of Medicine, Shizuoka, Japan.
Takahisa
T
Furuta
D000368:Aged; D018450:Disease Progression; D016145:Endoscopy, Digestive System; D050782:Esophageal pH Monitoring; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D007738:Kyphosis / Q000150:complications* / Q000453:epidemiology / Q000601:surgery; D008297:Male; D010027:Osteotomy / Q000379:methods*; D011184:Postoperative Period; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013904:Thoracic Vertebrae / Q000601:surgery*
frequency scale for the symptoms of GERD (FSSG); gastroesophageal reflux disease (GERD); osteoporosis; spinal kyphotic deformity; surgical spinal correction