Abstracts
2002 Digestive Disease Week

# 106020 Abstract ID: 106020 Laparoscopic Antireflux Surgery for Non-Erosive Reflux Disease (NERD): Comparison with Outcomes of Surgery for Erosive Esophagitis and Barretts Esophagus.
Reginald V Lord, Dino Elyassnia, Corinne T Sheth, Peter F Crookes, Jeffrey A Hagen, Stefan Oberg, Richard Gurski, Andrea Gattolin, Nagammapudur S Balaji, Steven Demeester, Jeffrey H Peters, Tom Demeester, Los Angeles, CA

Recent studies indicate that up to 60% of patients with gastroesophageal reflux have non-erosive reflux disease (NERD) with no endoscopic evidence of esophagitis. The outcome of acid suppression therapy in patients with NERD has been studied but few surgical studies have been reported. The aim of this study was to evaluate the outcome of laparoscopic antireflux surgery for symptomatic reflux disease in patients with NERD compared to the outcome for patients without NERD. 162 patients with abnormal distal esophageal acid exposure on 24 hour pH study who underwent laparoscopic Nissen fundoplication more than 12 months previously were studied (mean follow-up 36.5 months). 41 patients had a diagnosis of NERD and 121 had either no esophagitis at preoperative endoscopy but a history of esophagitis (healed esophagitis, 42 patients), esophagitis at the time of evaluation (35 patients), and 44 had Barretts esophagus. There were no significant differences between the patients with and without NERD with respect to age, sex, hiatal hernia, duration of follow-up, or presence or severity of preoperative heartburn or regurgitation. Preoperative moderate to severe dysphagia was less common in NERD patients (3/41, 7.7% versus 28/121, 23.1%, P=0.037). Outcome following fundoplication was similar with 87.8% of NERD patients and 87.6% of non-NERD patients reporting that they were cured or improved (P=1.0). However, there was a higher frequency of postoperative heartburn in the NERD group (10/41, 25.6% versus 10/121, 8.3%, P=0.01) and the proportion of patients reporting that they were satisfied or would have the same treatment again was smaller in the NERD group (84.6% satisfied, 87.2% would do again) than in the control group (95.9% and 96.7%, P=0.026 and 0.04). In conclusion, antireflux surgery provides similarly good or excellent outcomes for NERD and non-NERD reflux disease patients, but patients with NERD may complain more commonly of postoperative heartburn and may be less satisfied with treatment.