title: 24-hour pH-impedance monitoring on therapy to select patients with refractory reflux symptoms for antireflux surgery. A single center retrospective study.
abstract: BACKGROUND
  Treatment of gastro-esophageal reflux refractory symptoms is challenging. This monocenter retrospective study assessed the value of preoperative pH-impedance monitoring 'on' therapy to predict functional outcome after laparoscopic fundoplication in patients with refractory reflux symptoms.
  
  
  METHODS
  Patients with a preoperative pH-impedance monitoring 'on' proton pump inhibitors (PPIs) twice daily were assessed at least 6 months after a laparoscopic fundoplication for refractory reflux symptoms. Failure of fundoplication was defined by a Visick score > 2. Postoperative symptoms were assessed by the reflux disease questionnaire (RDQ). The pH-impedance parameters analyzed were the number of reflux events (total, acid, non-acid), esophageal acid exposure time, esophageal bolus exposure time, and symptom-reflux association defined by symptom index (SI) >50% and symptom association probability (SAP) >95%.
  
  
  RESULTS
  Thirty-three patients (18 female patients, median age 46 years) were assessed after a mean follow-up of 41.3 (range 7-102.2) months. Seven (21.2%) patients were considered as failures. Compared to patients with favorable outcome, these patients were more often 'on' PPI therapy (86% vs 23%, p < 0.05) and had higher RDQ scores in each domain: heartburn (p < 0.05), regurgitation (p < 0.05) and dyspepsia (p < 0.05). A positive SAP was the only pH-impedance parameter statistically associated with successful postoperative outcome (p = 0.004).
  
  
  CONCLUSIONS
  On therapy, a preoperative positive symptom association probability is the only pH-impedance parameter associated with favorable outcome after laparoscopic fundoplication for refractory reflux symptoms. These results should be confirmed by prospective studies.
authors.affiliation: Gastroenterology and Hepatology Department, Hôpital Saint André, Centre Hospitalier Universitaire de Bordeaux and Université de Bordeaux, Bordeaux, France.
authors.forename: M
authors.initials: M
authors.lastname: Desjardin
authors.affiliation: Digestive Surgery Department, Hôpital Haut Lévêque, Centre Hospitalier Universitaire de Bordeaux and Université de Bordeaux, Bordeaux, France.
authors.forename: G
authors.initials: G
authors.lastname: Luc
authors.affiliation: Digestive Surgery Department, Hôpital Haut Lévêque, Centre Hospitalier Universitaire de Bordeaux and Université de Bordeaux, Bordeaux, France.
authors.forename: D
authors.initials: D
authors.lastname: Collet
authors.affiliation: Gastroenterology and Hepatology Department, Hôpital Saint André, Centre Hospitalier Universitaire de Bordeaux and Université de Bordeaux, Bordeaux, France.
authors.forename: F
authors.initials: F
authors.lastname: Zerbib
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D004415:Dyspepsia / Q000209:etiology; D017097:Electric Impedance; D050782:Esophageal pH Monitoring; D005260:Female; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000150:complications / Q000378:metabolism* / Q000628:therapy; D006356:Heartburn / Q000209:etiology; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D054328:Proton Pump Inhibitors
keywords: fundoplication; gastro-esophageal reflux; pH-impedance monitoring