PH IMPEDANCE PARAMETERS ASSOCIATED WITH IMPROVEMENT IN GERD HEALTH-RELATED QUALITY OF LIFE FOLLOWING ANTI-REFLUX SURGERY
Morgan K. Johnson*2, Manasa Venkatesh2, Catherine R. Breuer2, Amber Shada2, Jacob A. Greenberg2, Anne O. Lidor2, Luke M. Funk2,1
1William S. Middleton VA Hospital, Madison, WI; 2University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI
Introduction: pH impedance monitoring is the most sensitive diagnostic test for detecting gastroesophageal reflux disease (GERD). Few studies have evaluated which parameters on preoperative pH impedance monitoring are associated with an improvement in heartburn symptoms after anti-reflux surgery. The objective of this study was to evaluate which parameters on preoperative pH impedance monitoring were associated with improved GERD health-related quality of life (GERD-HRQL) following anti-reflux surgery.
Methods: Data from our single academic institutional foregut database were used to identify patients with reflux symptoms who underwent anti-reflux surgery (Toupet or Nissen fundoplication) between <a href="tel:<a href="tel:01/2009-07">01/2009-07</a>">01/2009-07</a>/2019. Acid and impedance parameters were extracted from pH impedance studies. GERD-HRQL was assessed via symptom questionnaires administered in clinic or by phone during preoperative and postoperative visits. This 9-item questionnaire evaluates heartburn, dysphagia, and the impact of medication on daily life on a scale of 0 (no symptoms) to 5 (incapacitating symptoms). Total scores on the GERD-HRQL range from 0-45 with a higher score indicating more severe symptoms. Patient characteristics (gender, age, body mass index [BMI]), operative approach (Nissen vs. Toupet), and four pH impedance parameters were included in a multivariable linear regression model with improvement in GERD-HRQL (preoperative score - postoperative score) as the primary outcome.
Results: Our cohort included 217 patients (136 Nissen and 81 Toupet fundoplications). Preoperative GERD-HRQL data were available for 104 patients (following establishment of our institutional database and routine collection of preoperative GERD-HRQL data). The mean follow-up interval was 1.2 (SD+/-2.0) years. GERD-HRQL scores improved from 23.0 (SD+/-10.1) preoperatively to 4.6 (SD+/-6.6) postoperatively. For the entire cohort, none of the independent variables on bivariable or multivariable linear regression analyses were associated with improvements in GERD-HRQL. For patients with preoperative GERD-HRQL data available, a higher BMI and Toupet fundoplication were associated with greater GERD-HRQL improvement on multivariable analysis (Table 1). Younger age, lower acid exposure time, and a positive symptom index score trended toward associations with greater GERD-HRQL improvement (p<0.1 for each variable).
Conclusions: Of the four pH impedance parameters that were investigated, lower acid exposure time and a positive symptom index trended toward an association with greater improvement in quality of life after anti-reflux surgery. Future adequately powered prospective studies investigating outcomes following anti-reflux surgery may further elucidate the critical parameters for pH impedance testing.
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