Abstracts
1997 Digestive Disease Week

Outcomes of atypical reflux symptoms after laparoscopic fundoplication.

JBY So, DW Rattner. Department of Surgery, Massachusetts General Hospital, Harvard Medical School. Boston, MA.

Heartburn, regurgitation and recurrent aspiration are considered typical manifestations of gastroesophageal reflux diseases (GERD) whereas cough, asthma, chest pain, laryngitis, and epigastric pain are considered atypical symptoms of GERD. This study compares the efficacy of laparoscopic fundoplication(LF) for atypical and typical symptoms of GERD. Methods: 150 consecutive LF were performed over a three year period by the senior author. The primary symptom leading to a referral for surgery was classified as typical (n=115) or atypical (n=35). A history of heartburn was elicited in 31/35 patients with atypical symptoms. The efficacy of surgery was assessed by a symptom score index (scale 0-10) obtained pre-op and 6-18 months post-op. The median length of follow up was 21 months. Results: The response rate of laryngeal symptoms, atypical chest/epigastric pain, and respiratory symptoms was 80%, 58% and 48% respectively. 19/35 (54%) patients with atypical symptoms obtained relief with a mean improvement in their symptom score of 4.2 whereas 29/31(94%) patients with atypical symptoms as well as heartburn reported resolution of heartburn and mean improvement in symptom score of 6.3 (p=.01). The overall satisfaction score was lower in patients with atypical symptoms than those with heartburn alone (7.5 vs. 8.8 p=.03). Pre-op esophageal manometry and single electrode 24 hour pH probe testing did not correlate with successful relief of atypical symptoms. However dual electrode 24 hour pH testing in which the upper probe was positioned proximal to the cricopharyngeus accurately identified 5/6 patients with laryngeal symptoms who benefited from LF. Conclusion: 1. LF is less likely to relieve atypical symptoms attributed to GERD than typical symptoms. 2. Patients with laryngeal symptoms likely to respond to LF can be identified by dual pH probe testing. 3). This study was unable to identify pre-op characteristics or tests which predicted relief of chest pain, cough, and asthma by LF.