2005 Abstracts: Quality of Life in GERD Patients: Medical Treatment Versus Antireflux Surgery
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Quality of Life in GERD Patients: Medical Treatment Versus Antireflux Surgery
Ruxandra Ciovica, Michael Gadenstätter, Dept. of Surgery, General Hospital of Krems, Krems, Niederösterreich, Austria; Anton Klingler, Dept. of Surgery, University Hospital of Innsbruck, Innsbruck, Tirol, Austria; Katja Ruzicka, Otto Riedl, Gerhard P. Schwab, Dept. of Surgery, General Hospital of Krems, Krems, Niederösterreich, Austria
Purpose: Medical and surgical treatment are able to improve symptoms in patients with gastroesophageal reflux disease (GERD). The aim of this study was to evaluate the quality of life in GERD patients without therapy, under continuous medical treatment and following laparoscopic antireflux surgery.
Methods: 579 consecutive GERD patients underwent medical or surgical treatment at a single department. All patients were studied in detail before and after treatment (symptom questionnaire, upper gastrointestinal endoscopy, esophageal manometry, 24-hour esophageal pH-monitoring, barium esophagogram). Surgery was indicated and performed in patients with persistent or reccurent GERD symptoms and/or complications despite of an adequate medication and in patients preferring surgery to medical treatment. The remaining patients were treated with proton pump inhibitors (PPI) in the standard or if required the double dose. The quality of life index was measured by the means of Gastrointestinal Quality of Life Index (GIQLI) and GERD-Health-Related Quality of Life questionnaire (HRQL). Results: All patients (median age 52 years, range 22-74 years) had a positive history of heartburn, the mean duration of symptoms was 9.5 years (range 1-40 years). 80% of all patients had a defective LES, a positive DeMeester Score was found in 74%. 351 patients (61%) underwent laparoscopic antireflux surgery, the remaining 228 patients (39%) were treated with proton pump inhibitors. While quality of life was highly impaired in GERD patients without therapy compared to normals (GIQLI 122 points, HRQL 0 points), a significant improvement was obtained by PPI therapy (table). Following surgery quality of life was normalized in all subsections and was significantly higher compared to the medically treated group. These results stayed constant in the short and intermediate follow-up. Conclusions: Medical and surgical therapy are both able to improve quality of life in GERD patients. Nevertheless, the outcome is significantly better following surgery. It can be suggested that surgical treatment may be the more successful therapy in the long-term.| Quality of life tests | Without therapy | PPI therapy | 3 months postop. | 12 months postop. |
| GIGLI | 95 (79-108) | 104 (89-117) * | 119 (104-130) ** | 119 (106-130) ** |
| HRQL | 20 (13-28) | 12 (6-19) * | 2 (0-4) ** | 1 (0-4) ** |
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