Abstracts
2000 Digestive Disease Week

# 2258 Laparoscopic Fundoplication for Symptomatic But Physiologic Gastroesophageal Reflux.
Reginald C. W. Bell, Philip D. Hanna, Sandy Brubaker, Boulder, CO, Englewood, CO

Esophageal pH monitoring identifies some patients who have physiologic amounts of esophageal acid exposure but have a strong correlation between symptoms of esophageal reflux and esophageal reflux events. These patients with symptomatic physiologic reflux (SPR) probably have enhanced sensory perception of reflux events, and may be difficult to control with acid suppressive therapy. Little is known about the role of antireflux surgery in this group. Methods: Patients with no endoscopic evidence of GERD and a normal 24-hour pH composite score (< 22.4 in our lab), but a symptom index (SI = # of symptoms/# of acid reflux events) of > 50% were offered laparoscopic fundoplication if acid suppressive therapy was unsatisfactory. This group comprised 18 (4%) of 459 patients undergoing fundoplication in our institution. Heartburn, dysphagia, and reflux symptoms were scored on a scale of 0-10 on and off medicine preoperatively, and at a mean of 7.2 months (1-32) postoperatively. Results: The 18 patients with SPR (6 M, 12 F) had heartburn as a major complaint. Preoperative response to proton pump inhibitors for heartburn symptoms was 72%, and for all symptoms was 60%. The group had a mean pH composite score of 14 (range, 4-22). The symptom used to calculate the SI was heartburn in 12, regurgitation in 3, chest pain in 2, and cough in 1 patient. An average of 18 symptoms (2-56) were recorded.The mean SI was 82% (range, 50%-100%). A Nissen was performed in 9 cases and a Toupet in 9. Surgery was successful in alleviating reflux symptoms in 14 patients and partially successful (> 75%) in the remaining 3(Table). Gas-bloat and dysphagia were seen in 1 patient each. Conclusions: Antireflux surgery is effective at relieving reflux symptoms in carefully selected patients with symptomatic physiologic reflux, with minimal side effects.