PH TESTING SYMPTOM INDEX SCORING DOES NOT PREDICT PATIENT SATISFACTION AFTER ANTIREFLUX SURGERY
Amber Shada*, Lily Stalter, Luke M. Funk, Anne O. Lidor
Surgery, University of Wisconsin Hospital & Clinics, Madison, WI
Introduction: pH testing is mandatory prior to antireflux surgery for patients who lack objective findings of esophageal acid exposure (per the Lyon consensus). Both acid exposure time (>4-6% for off PPI studies) and number of reflux events (>72) are routinely used to determine candidacy for antireflux surgery. Symptom reproducibility, calculated as symptom index, is used by some to predict whether antireflux surgery will be of benefit. We sought to determine whether symptom index was associated with satisfaction post-antireflux surgery. We hypothesized that patients whose symptom index (for heartburn, regurgitation, or chest pain) was positive on their pH testing preoperatively experienced greater improvements in GERD HRQL and a higher rate of "satisfied" scoring.
Methods: This is a retrospective review of a prospectively collected dataset from a single tertiary care institution. Patients were included if they underwent fundoplication or LINX, and also had preoperative pH testing (either pH impedance testing or wireless 48-hour BRAVO testing). Patients who underwent redo antireflux surgery, had a diagnosis of achalasia or underwent concurrent esophageal myotomy were excluded. Patients were grouped into a Positive SI group if they had at least one symptom index >50% during their pH testing. Validated QOL tools, including the GERD HRQL, GCSI, and Eckart score were collected preoperatively, at 6 weeks and one year postoperatively. Satisfaction was defined as a patient reported affirmative answer to the question "Would you choose to undergo this surgery again?"
Results: A total of 373 patients met inclusion criteria and were evaluated. Mean age was 50.8 years and mean BMI was 29.5. The majority of patients (78%) had a positive symptom index for at least one symptom. This Positive SI (PSI) group had a mean AET of only 5.3%, as compared to 6.4% in the Negative SI (NSI) group (p=0.33). The PSI group had a greater number of total reflux events (87 vs 57) and proximal reflux events (43 vs 23) (p<0.001). Satisfaction at 6 weeks of 71% for PSI and 80% for NSI was comparable between groups. This increased in both groups to 82% for PSI and 93% for NSI at one year. In both groups, the vast majority of patients (96.7%) said they would choose to undergo surgery if offered again.
Conclusion: Patients with a Positive Symptom Index experienced the same degree of improvement in GERD HRQL as those with NSI. Overall satisfaction with antireflux surgery is high in properly selective patients who undergo confirmatory pH testing ahead of surgery, regardless of PSI or NSI during pH testing.
Back to 2023 Posters