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IMPROVEMENTS IN QUALITY OF LIFE AND OBJECTIVE PATIENT CHARACTERISTICS ARE SEEN AFTER MAGNETIC SPHINCTER AUGMENTATION
Kirsten Newhams^*, Anne Meslang, Adam Alleyne, Samantha Martin, Kristy Chovanec, Philip Jackson, Emily Smith, Ali H. Zaidi, Blair A. Jobe
Western Pennsylvania Hospital, Pittsburgh, PA
Background:Gastroesophageal reflux disease (GERD) is a complex disease with an evolving array of therapeutic interventions available. Magnetic sphincter augmentation (LINX, TORAX Medical) is a relatively new approach to the treatment of GERD.
Aim: To establish improvement in quality of life (QoL) and objective patient findings following magnetic sphincter augmentation.
Patients and Methods: Retrospective case review of a prospectively maintained database. With IRB approval, data was evaluated on 366 patients who underwent magnetic sphincter augmentation. Validated GERD-HRQL (heartburn, regurgitation and total), RSI and dysphagia questionnaires were provided to patients preoperatively and at 6 months and 1 year. 192 patients completed GERD-HRQL questionnaires preoperatively, with 153 completing them at 6 months and 100 completing them at 1 year. 201 patients completed the RSI questionnaire preoperatively with 153 completing it at 6 months and 103 at 1 year. 132 patients completed the preoperative dysphagia questionnaire preoperatively with 97 completing it at 6 months and 82 completing it at 1 year. There was a significant difference between baseline scores and scores at 6 month and 1 year follow up of all GERD-HRQL, RSI and dysphagia scores (ANOVA). Objective patient characteristics were obtained and evaluated. Preoperative and one year postoperative DeMeester scores from impedance and Bravo pH testing were evaluated with McNemar's test. Additionally, esophagitis and proton pump inhibitor (PPI) medications use were evaluated.
Results: There was a significant improvement in scores from baseline to 6 months and 1 year (p=.000) for GERD-HRQL total, regurgitation, and heartburn as well as RSI and dysphagia scores. Preoperatively, 88% of patients were dissatisfied with their quality of life with 72% patients satisfied and 10% dissatisfied at 1 year follow up. At 1 year follow up, 93% patients had discontinued PPIs (p=.0001). A smaller subset of patients was evaluated using McNemar's test. Out of a total of 60 patients, 48 had a positive baseline DeMeester score (>14.72), while 12 had a negative score. The average DeMeester score declined from 32.9 preoperatively to 14.1 postoperatively. At 1 year, 23 patients had a positive DeMeester score while 37 had a negative DeMeester score (p=.00001), demonstrating a significant normalization in the pH score. Lastly, esophagitis completely in a third of the patients.
Conclusion: Following magnetic sphincter augmentation, significant improvement is seen in quality of life and objective patient characteristics. Nearly all patients will remain off PPI medications at 1 year. Magnetic sphincter augmentation is a promising technique available in the armamentarium of the surgeon seeking to treat GERD. A detailed dataset will be presented in full at Digestive Disease Week, 2018.

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