Introduction: Gastroesophageal reflux disease symptoms can be classified as esophageal (heartburn, regurgitation) or extraesophageal (cough, throat clearing, hoarseness). Patients may suffer from isolated esophageal (GERD), purely extraesophageal (laryngopharyneal reflux or LPR), or a combination of symptoms (mixed) from each category. Antireflux surgery outcomes, side effects, and patient satisfaction may vary according to preoperative symptom classification.
Methods: From a prospectively maintained database (August 2002 to June 2006), 97 patients to undergo laparoscopic Nissen fundoplication were identified. All patients suffered from symptoms despite high dose medical therapy. Patients were placed into one of 3 categories based on their pre-op symptoms: GERD, LPR, or mixed. Symptom surveys were mailed and returned by 58 (60%). Surveys included a GI Quality of Life Index (GIQLI, possible score 0-144). Supplemental questions regarding cough, throat clearing, and hoarseness were included. Responses for all survey items were graded on a 5 point Likert scale (0=least desirable/constant or severe to 4=most desirable/symptom absent).
Results: Mean follow-up was 24 months (range 3-48) and identical in all groups. Gender and age were similar in all groups. In the table below, HCC=sum of response scores for hoarseness, cough and throat clearing questions. BLOAT=sum of responses for questions 2-5 on GIQLI: upper abdominal fullness, bloating, excess flatus, belching (higher score = fewer symptoms for HCC and BLOAT). Following surgery, heartburn was rare or non-existent in 91.3% of GERD, 100% LPR, and 79.2% mixed (p=ns).
Conclusions: Patient satisfaction following antireflux surgery is highest in patients with purely esophageal symptoms pre-op. GIQLI scores are close to those attained in subjects without GI disease (125.8 +/-13) in GERD and LPR, but impaired in those patients with mixed symptoms. Patients with mixed symptoms pre-op also suffer from more gas bloat symptoms following surgery than do patients in other categories. The mixed classification may represent a more advanced disease state in which the surgical outcomes are less optimal.

	GERD (n=23)	LPR (n=11)	Mixed (n=24)
GIQLI	116.3	118.4	105.9*
Satisfaction (0-4)	3.7*	3.1	2.9
HCC (0-12)	10.3*	7.6	8.0
BLOAT (0-16)	11.2	10.3	8.8*

* = difference statistically significant from values in other 2 categories (p<0.05)