Surgical Management of Gastroesophageal Reflux Disease in Patients with Severe Esophageal Dysmotility
| Autor: | Priscila R. Armijo, Melissa Leon, Austin Wheeler, Dmitry Oleynikov, Dietric Hennings, Akshay Pratap |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Manometry Population Fundoplication Achalasia 030230 surgery Gastroenterology Esophageal Sphincter Lower Hiatal hernia 03 medical and health sciences 0302 clinical medicine Recurrence Internal medicine Humans Medicine education Aged education.field_of_study business.industry Reflux Proton Pump Inhibitors Middle Aged medicine.disease Dysphagia digestive system diseases Hernia Hiatal Treatment Outcome Esophageal motility disorder 030220 oncology & carcinogenesis Gastroesophageal Reflux GERD Female Laparoscopy Peristalsis Surgery Esophageal spasm Antacids medicine.symptom Deglutition Disorders business Follow-Up Studies |
| Zdroj: | Journal of Gastrointestinal Surgery. 23:36-42 |
| ISSN: | 1873-4626 1091-255X |
| Popis: | Gastroesophageal reflux disease (GERD) and esophageal dysmotility are often disqualifying criteria for fundoplication due to dysphagia complications. A tailored partial fundoplication may improve GERD in patients with severe esophageal motility disorders. We evaluate this approach on GERD improvement in non-achalasia esophageal dysmotility patients. A single-institution prospective database was reviewed (2007–2016), with inclusion criteria of GERD, previous diagnosis of non-achalasia esophageal motility disorder, and laparoscopic partial fundoplication. Diagnosis of previous achalasia diagnosis or diffused esophageal spasm was excluded. Motility studies, pre- and post-upper gastrointestinal imaging (UGI), esophageal symptom scores, antacid, and PPI use were collected pre-op, 6 months, 12 months, and long-term (LT). Statistical analysis was made using SPSS v.23.0.0, α = 0.05. Fifty-two patients met the inclusion criteria. A total of 17.3% had esophageal body amotility, 79.6% had severe esophageal dysmotility. A total of 65.9% women (mean age 64 ± 15.7), mean peristalsis 45.3 ± 32.6%, and failed peristalsis 36.0 ± 32.2%. Mean LES residual pressure was 15.0 ± 18.0 mmHg, and 40.7% had hypotensive LES. Mean follow-up time was 25 months [1–7 years], with significant improvement in symptoms and reduction in PPI and antacid use at all time-points compared to pre-op. A total of 74% had UGI studies at 12 months; all showed persistent dysmotility. Six patients had radiographic hiatal hernia recurrence, with only one being clinically symptomatic postoperatively. Three required dilation for persistent dysphagia. A tailored partial fundoplication may be effective in symptom relief for non-achalasia patients with esophageal motility disorders and GERD. Significant symptom improvement, low HHR, and PPI use clearly indicate this approach to be effective for this population. |
| Databáze: | OpenAIRE |
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