Abstracts
1998 Digestive Disease Week

#1085

ASTHMA AND GASTROESOPHAGEAL REFLUX: FUNDOPLICATION DECREASES NEED FOR SYSTEMIC CORTICOSTEROIDS. Hadar Spivak, C. Daniel Smith, Alounthith Phichith, Kathy Galloway, Patrick J. Waring, John G. Hunter Department of Surgery and Medicine, Emory University School of Medicine, Atlanta, Georgia.

An association between gastroesophageal reflux (GER) and asthma has been suggested for many decades. While antireflux therapy (medical and surgical) has been shown to be beneficial in asthma patients, response to therapy has not been well quantified. The aim of this study was to evaluate the long-term outcome in patients with asthma associated with GER undergoing fundoplication.

METHODS: From a database of over 600 patients with GER treated surgically between 1991 and 1996, 39 patients with asthma associated with GER as their primary indication for surgery were identified. Preoperatively, all patients in this group rated asthma symptoms as severe or incapacitating despite intensive medical therapy with proton pump inhibitors and prokinetic agents. Asthma symptom scores (NIH) and medication frequency scores were determined preoperatively and at latest follow-up (mean 2.5 years). Comparisons were made using the Wilcoxon rank sum test. RESULTS: Asthma symptom scores and medication frequency scores both decreased significantly after antireflux surgery:

ASTHMA SCORES (NIH)

	asthma attacks	cough wheezing	exercise tolerance	nocturnal asthma	school or work
preop	3.4 ± 1.0	3.5 ± 0.8	3.6 ± 0.8	3.1 ± 1.1	3.0 ± 0.9
postop	1.9 ± 1.6	2.2 ± 1.5	3.0 ± 0.8	1.9 ± 1.5	2.6 ± 0.8
p	0.0001	0.0001	0.0001	0.0001	0.03

MEDICATION FREQUENCY SCORE

	Systemic Agents		Inhalation Agents
	broncholdilator	steroid	non-steroid	steroid
preop	3.0 ± 1.7	2.2 ± 1.4	3.3 ± 1.4	3.3 ± 1.5
postop	1.1 ± 1.7	0.7 ± 1.4	3.3 ± 1.4	2.9 ± 1.6
p	0.054	0.0001	0.85	0.36

Of the nine patients who required daily oral corticosteroid, seven (78%) were able to discontinue treatment. Pre and post procedure 24 hour pH monitoring, available in nine patients, revealed abnormal pH studies in all patients preoperatively (mean reflux time = 17%) and was normal in all postoperatively (mean reflux time = 2%). CONCLUSION: In patients with GER and asthma, symptoms of asthma are improved following fundoplication. Especially important is the ability to wean patients off systemic corticosteroids and bronchodilators. We suggest that all patients with steroid dependent asthma should be evaluated for GER, be aggressively treated and referred for surgery if asthma control is not complete on medical antireflux therapy.

Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.