The Effect of Chronic Pain Syndromes and Psychoemotional Disorders on Patient Satisfaction after Antireflux Surgery
Abstracts
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Background: Patient satisfaction with antireflux surgery can be affected by factors other than alleviation of pathologic reflux. The purpose of this study was to determine the outcomes of patients with chronic pain syndromes (CPS)or psychoemotional disorders (PED) undergoing antireflux surgery for GERD. Methods: A review of all patients undergoing anitreflux surgery with at least three months follow-up (range 3-56 months) was completed. Patients were divided into two groups: those without CPS/PED (i.e., controls, n=134) and those with CPS/PED (i.e., fibromyalgia, chronic fatigue syndrome, depression, and anxiety disorders, n=28). All patients had symptomatic GERD, and objective physiologic documentation of pathologic reflux (i.e., upper endoscopy, 24 hr. pH monitoring, and manometry). Patients with paraesophageal hernias were excluded. Results: 93% of control patients were satisfied with surgery, compared to 25% of CPS/PED patients (p<0.001). Causes for dissatisfaction in control patients were related to failure or complications of surgery (10); whereas, in CPS/PED patients, causes were vague somatic pains (21), dysphagia (3), and heartburn (1). Conclusions: Patients with CPS/PED are generally dissatisfied with the results of antireflux surgery. Their dissatisfaction stems from persistent somatic complaints, rather than GERD-related. This may be the result of an accentuated response to pain, or perhaps associated functional gastrointestinal syndromes. |
