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POSITIVE SYMPTOM ASSOCIATED PROBABILITY IS ASSOCIATED WITH DURABLE IMPROVEMENTS IN QUALITY OF LIFE 6 YEARS FOLLOWING LAPAROSCOPIC FUNDOPLICATION
Karla Bernardi*, Lauren Hawley, Anahita D. Jalilvand, Vivian L. Wang, Kelly Haisley, Kyle A. Perry
The Ohio State University, Columbus, OH

Background: Laparoscopic fundoplication (LF) is the gold standard surgical treatment for patients with gastroesophageal reflux disease (GERD). Symptom association probability (SAP) score is used to correlate symptoms to reflux events, with scores above 95% implying high correlation. It is unknown whether SAP scores are correlated with the long-term outcomes of LF. We hypothesized that patients with a positive SAP for at least one GERD symptom derive greater long-term improvement in disease-specific quality of life (QoL) following LF compared to those with negative SAP scores.
Methods: We tested this hypothesis in a retrospective cohort study of 176 consecutive patients undergoing LF for GERD between 2011-2014 at a large academic institution. Patients without pH testing or SAP scores were excluded (n=80). SAP scores >95% were considered positive and those <95% negative. Reflux symptoms and QoL were assessed using the Gastroesophageal Reflux Symptom Scale (GERSS) and Gastroesophageal Reflux Disease Health-Related Quality of Life (GERD-HRQL) questionnaires. Long-term follow-up data were collected by telephone interview, and complete data were available for 69% of patients. Patients were stratified by presence (PSAP, n=70) or absence (NSAP, n=26) of a positive SAP score for at least one GERD symptom. The primary outcome was the GERD-HRQL score at long-term follow-up, while GERSS score, PPI use, and patient satisfaction were secondary outcomes. Data are presented as incidence (%), mean ± SD, or median (IQ range) as appropriate, and a p-value of <0.05 was considered statistically significant.
Results: Sixty-six patients met the inclusion criteria and completed long-term follow-up with a median interval of 71.5 (63-92) months. Of these, 46 (70%) were in the PSAP group compared to 20 (30%) in the NSAP group. Baseline characteristics, presence of hiatal hernia, and preoperative DeMeester score did not differ between groups. At long-term follow-up, patients in the PSAP group had GERD-HRQL scores of 6.5 (2-13) compared to 11.5 (6.5-19.5) for patients in the NSAP group (p=0.04). These patients also reported GERSS scores of 7 (1-18) and 16.5 (10.5-23.5) respectively (p=0.02). PPI cessation was maintained in 67% of patients in the PSAP group compared to 50% of NSAP patients (p=0.147) and 87% of PSAP patients reported postoperative satisfaction compared to 70% of NSAP patients (p=0.07).
Conclusion: Positive SAP scores are associated with improved symptom and disease-specific quality of life scores 6 years following LF for GERD. Patients with positive symptom correlation also showed a trend toward increased postoperative satisfaction. This information may help guide preoperative discussions to set realistic expectations for outcomes of reflux surgery. Larger studies are needed to clarify the impact of SAP on long-term satisfaction and PPI cessation.


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