Abstracts
2001 Digestive Disease Week

# 227 Absence of Gasroesophageal Reflux Disease in a Majority of Patients Taking Acid Suppression Medications After Nissen Fundoplication
Reginald V. Lord, Anna Kaminski, David J. Bowrey, Peter F. Crookes, Michael G. Wood, Rodney Mason, Saj Wajed, Jeffrey A. Hagen, Steven R. DeMeester, Christopher G. Streets, Jeffrey H. Peters, Tom R. DeMeester, Los Angeles, CA

BACKGROUND: The observation that many patients are taking acid suppressant medications after laparoscopic antireflux surgery has been promoted as evidence that antireflux surgery is often ineffective. The aim of this study was to determine the frequency of reflux disease in a cohort of surgically-treated patients who had symptoms suggestive of recurrent reflux and a high prevalence of antireflux medication use.

METHODS: Eighty six consecutive post-Nissen fundoplication patients who had undergone distal esophageal pH monitoring with completion of a detailed symptom questionnaire were studied. Fundoplication was performed laparoscopically in 70% of cases. The mean postoperative follow-up period was 28 months (range 0-192). All patients had postoperative symptoms that were severe enough to require detailed investigation. The symptoms were heartburn of any severity in 71% of patients, moderately severe or severe heartburn in 57%, dysphagia (any 62%; moderately severe or severe 42%), regurgitation (58%; 49%), and chest pain (55%; 37%). Thirty-seven patients (43%) were taking acid suppressant medications after fundoplication.

RESULTS: Only 20 (23%) of the patients had objective gastroesophageal reflux disease on the 24 hour pH study and only 9 (14%) of the 63 patients who underwent postoperative endoscopy had endoscopic esophagitis (erosive esophagitis in 2 patients). There was no significant difference in the prevalence of reflux disease among those taking and not taking acid suppressant medications (24.3% vs 23.3%; Fisher s exact test p=1.0).
CONCLUSIONS: Symptoms occurring after antireflux surgery are unlikely to be due to recurrent gastroesophageal reflux disease. Objective evidence of reflux disease should be obtained before prescribing acid suppression medication.