pH Impedance Parameters Associated with Improvement in GERD Health-Related Quality of Life Following Anti-reflux Surgery.

Autor: Johnson MK; Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA., Venkatesh M; Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA., Liu N; Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA., Breuer CR; Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA., Shada AL; Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA., Greenberg JA; Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA., Lidor AO; Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA., Funk LM; Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA. funk@surgery.wisc.edu.; William S. Middleton Memorial VA Hospital, Madison, WI, USA. funk@surgery.wisc.edu.
Jazyk: angličtina
Zdroj: Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract [J Gastrointest Surg] 2021 Jan; Vol. 25 (1), pp. 28-35. Date of Electronic Publication: 2020 Oct 27.
DOI: 10.1007/s11605-020-04831-z
Abstrakt: Introduction: pH impedance testing is the most sensitive diagnostic test for detecting gastroesophageal reflux disease (GERD). The literature remains inconclusive on which preoperative pH impedance testing parameters are associated with an improvement in heartburn symptoms after anti-reflux surgery. The objective of this study was to evaluate which parameters on preoperative pH impedance testing were associated with improved GERD health-related quality of life (GERD-HRQL) following surgery.
Methods: Data from a single-institution foregut database were used to identify patients with reflux symptoms who underwent anti-reflux surgery between 2014 and 2020. Acid and impedance parameters were extracted from preoperative pH impedance studies. GERD-HRQL was assessed pre- and postoperatively with a questionnaire that evaluated heartburn, dysphagia, and the impact of acid-blocking medications on daily life. Patient characteristics, fundoplication type, and four pH impedance parameters were included in a multivariable linear regression model with improvement in GERD-HRQL as the outcome.
Results: We included 108 patients (59 Nissen and 49 Toupet fundoplications), with a median follow-up time of 1 year. GERD-HRQL scores improved from 22.4 (SD ± 10.1) preoperatively to 4.2 (± 6.2) postoperatively. In multivariable analysis, a normal preoperative acid exposure time (p = 0.01) and Toupet fundoplication (vs. Nissen; p = 0.03) were independently associated with greater improvement in GERD-HRQL.
Conclusions: Of the four pH impedance parameters that were investigated, a normal preoperative acid exposure time was associated with greater improvement in quality of life after anti-reflux surgery. Further investigation into the critical parameters on preoperative pH impedance testing using a multi-institutional cohort is warranted.
Databáze: MEDLINE
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