Abstracts
2002 Digestive Disease Week

# 107327 Abstract ID: 107327 Laparoscopic Antireflux Surgery Improves the Quality of Life of GERD Patients Better than Medical Therapy.
Mario Costantini, Giovanni Zaninotto, Barbara Gnocato, Magdalena Epifani, Michela Costantino, Loredana Nicoletti, Daniela Molena, Giuseppe Portale, Cristian Rizzetto, Padova, Italy

The modification of the Quality of Life (QoL) of patients has became an important factor in evaluating the efficacy of a given treatment. Several indexes have been developed: the GIQLI (GastroIntestinal Quality of Life Index) has been especially used for gastrointestinal diseases. In this study we evaluated the QoL in a group of 57 consecutive patients before and after a laparoscopic Nissen fundoplication (Group A, 35 M, 22 F, median age 51). 27 patients with 24-h pH-proven GERD that preferred to continue medical treatment (Group B, 20 M, 7 F, median age 46), and 16 patients with GERD-like symptoms but normal pH-monitoring (Group C, 7 M, 9 F, median age 49) were also evaluated before and after 6 months of continuous medical therapy. A group of 71 healthy volunteers (42 M, 29 F, median age 51) served as control group. All patients underwent detailed questionnaire for symptom scoring, endoscopy, esophageal manometry and 24-hour pH-monitoring. In addition, the GIQLI questionnaire, based on 36 items grouped in 5 categories (symptoms, emotional, physical, social, pharmacological), was administered to the patients. The symptom score and the GIQLI questionnaire was also filled 6 months after the treatment. Results: Before treatment, the median GIQLI score was similar in all the 3 groups of patients, and significantly lower compared to the control group (95 (66-115), 92 (69-112) and 90 (68-134), respectively for Group A, B and C, vs 127 (90-142) of controls). All the 3 groups of patients similarly improved their median GIQLI score (105 (79-120), 103 (69-124) and 92 (72-125), respectively for Group A, B and C, p=n.s.). The median percent increase in the score was 8%, 9% and 2%, respectively for Group A, B and C (p=n.s.). However, when evaluating the single patients (paired data), patients of Group A showed a significant improvement in the total GIQLI score as well as in any single item category (with the exception of the social one); patients of Group B showed a difference in the total score and only in 2 out of 5 item categories (symptoms & emotional); finally, patients of Group C showed no differences in their GIQLI score after treatment. Comment: GERD patients have a poor basal GIQLI index. Appropriate surgical or medical therapy improves their QoL: in this aspect, surgical therapy seems more beneficial than medical therapy, that is also effective. GERD-like patients have a poor basal QoL, too. This does not change after medical therapy that, obviously, cannot address the basal alteration responsible for their illness.