Early and Midterm Outcome After Laparoscopic Fundoplication and a Minimally Invasive Endoscopic Procedure in Patients with Gastroesophageal Reflux Disease: A Prospective Observational Study

Liang, Weitao; Chen, Yan; Wang, Zhonggao; Wu, Ji-Min; Hu, Zhiwei; Zhan, X L; Wang, Feng; Ma, Song-Song; Chen, Mei‐Ping

doi:10.1089/lap.2015.0188

Cited by 26 publications

(12 citation statements)

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“…Gastroesophageal reflux (GER), and especially nocturnal GER (nGER), is associated with many symptoms from the respiratory tract, often asthma symptoms [ 1 – 3 ]. However, it is not fully known how GER patients with asthma symptoms differ from other asthma patients, and what the pathogenic mechanisms are.…”

Section: Introductionmentioning

confidence: 99%

Respiratory symptoms, sleep-disordered breathing and biomarkers in nocturnal gastroesophageal reflux

et al. 2016

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BackgroundNocturnal gastroesophageal reflux (nGER) is associated with respiratory symptoms and sleep-disordered breathing (SDB), but the pathogenesis is unclear. We aimed to investigate the association between nGER and respiratory symptoms, exacerbations of respiratory symptoms, SDB and airway inflammation.MethodsParticipants in the European Community Respiratory Health Survey III in Iceland with nGER symptoms (n = 48) and age and gender matched controls (n = 42) were studied by questionnaires, exhaled breath condensate (EBC), particles in exhaled air (PEx) measurements, and a home polygraphic study. An exacerbation of respiratory symptoms was defined as an episode of markedly worse respiratory symptoms in the previous 12 months.ResultsAsthma and bronchitis symptoms were more common among nGER subjects than controls (54 % vs 29 %, p = 0.01; and 60 % vs 26 %, p < 0.01, respectively), as were exacerbations of respiratory symptoms (19 % vs 5 %, p = 0.04). Objectively measured snoring was more common among subjects with nGER than controls (snores per hour of sleep, median (IQR): 177 (79–281) vs 67 (32–182), p = 0.004). Pepsin (2.5 ng/ml (0.8–5.8) vs 0.8 ng/ml (0.8–3.6), p = 0.03), substance P (741 pg/ml (626–821) vs 623 pg/ml (562–676), p < 0.001) and 8-isoprostane (3.0 pg/ml (2.7–3.9) vs 2.6 pg/ml (2.2–2.9), p = 0.002) in EBC were higher among nGER subjects than controls. Albumin and surfactant protein A in PEx were lower among nGER subjects. These findings were independent of BMI.ConclusionIn a general population sample, nGER is associated with symptoms of asthma and bronchitis, as well as exacerbations of respiratory symptoms. Also, nGER is associated with increased respiratory effort during sleep. Biomarker measurements in EBC, PEx and serum indicate that micro-aspiration and neurogenic inflammation are plausible mechanisms.

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Section: Introductionmentioning

confidence: 99%

Respiratory symptoms, sleep-disordered breathing and biomarkers in nocturnal gastroesophageal reflux

et al. 2016

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“…[ 1 – 3 ] Since the first laparoscopic Nissen fundoplication (LNF) was described in 1991, [ 4 ] extensive studies regarding laparoscopic antireflux surgery have been reported, demonstrating an established role of fundoplication for the treatment of GERD. [ 5 – 7 ] As the most widely used surgical treatment of GERD, LNF is associated with some unwanted functional disorders, such as dysphagia, gas-bloating syndrome. To minimize the risk of these complications, a variety of modifications of LNF have been launched.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic Nissen (total) versus anterior 180° fundoplication for gastro-esophageal reflux disease

et al. 2017

Medicine

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Background:Laparoscopic Nissen fundoplication (LNF) has been the gold standard for the surgical management of Gastro-esophageal reflux disease (GERD). Laparoscopic anterior 180° fundoplication (180° LAF) is reported to reduce the incidence of postoperative complications while obtaining similar control of reflux. The present meta-analysis was conducted to confirm the value of the 2 techniques.Methods:PubMed, Medline, Embase, Cochrane Library, Springerlink, and China National Knowledge Infrastructure Platform databases were searched for randomized controlled trials (RCTs) comparing LNF and 180° LAF. Data regarding the benefits and adverse results of 2 techniques were extracted and compared using a meta-analysis.Results:Six eligible RCTs comparing LNF (n = 266) and 180° LAF (n = 265) were identified. There were no significant differences between LNF and 180° LAF with regard to operating time, perioperative complications, length of hospital stay, patient satisfaction, willingness to undergo surgery again, quality of life, postoperative heartburn, proton pump inhibitor (PPI) use, postoperative DeMeester scores, postoperative lower esophageal sphincter (LES) pressure, postoperative gas-bloating, unable to belch, diarrhea, or overall reoperation. LNF was associated with a higher prevalence of postoperative dysphagia compared with 180° LAF, while 180° LAF was followed by more reoperation for recurrent reflux symptoms.Conclusion:LNF and 180° LAF are equally effective in controlling reflux symptoms and obtain a comparable prevalence of patient satisfaction. 180° LAF can reduce the incidence of postoperative dysphagia while this is offset by a higher risk of reoperation for recurrent symptoms. The risk of recurrent symptoms should need to be balanced against the risk of dysphagia when surgeons choose surgical procedures for each individual with GERD.

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“…Moreover, up to 40% of GERD patients are refractory to PPIs[ 14 , 15 ]. In our previous study, we demonstrated that laparoscopic Toupet fundoplication (LTF) was more effective than the Stretta procedure in controlling GERD symptoms[ 16 ]. However, the effects of reflux on the upper respiratory tract, including chronic cough, asthma, expectoration, breathlessness and laryngospasm, seriously affect the quality of life of GERD patients [ 17 – 19 ].…”

Section: Introductionmentioning

confidence: 99%

Diagnosis and Anti-Reflux Therapy for GERD with Respiratory Symptoms: A Study Using Multichannel Intraluminal Impedance-pH Monitoring

Zhang

et al. 2016

PLoS ONE

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Background/AimsRespiratory symptoms are often associated with gastroesophageal reflux disease (GERD). Although the role of multichannel intraluminal impedance–pH (MII-pH) monitoring in GERD is clear, little is known regarding the characteristics of patients with respiratory symptoms based on MII-pH monitoring and anti-reflux therapy. We evaluated a cohort of GERD patients to identify the MII-pH parameters of GERD-related respiratory symptoms and to assess the anti-reflux therapy outcomes.MethodsWe undertook a prospective study of patients who were referred for GERD evaluation from January 2011 to January 2012. One hundred ninety-five patients underwent MII-pH monitoring and esophageal manometry, and one hundred sixty-five patients underwent invasive anti-reflux therapy that included laparoscopic Toupet fundoplication (LTF) and the Stretta procedure. The patient characteristics and MII-pH parameters were analyzed, and the symptom scores were assessed at baseline and at 1- and 3-year follow-up evaluations.ResultsOf the 195 patients, 96 (49.2%) exhibited respiratory symptoms and significantly more reflux episodes (70.7±29.3) than patients without respiratory symptoms (64.7±24.4, p = 0.044) based on the MII-pH monitoring results. Moreover, the group of patients with respiratory symptoms exhibited more proximal reflux episodes (35.2±21.3) than the non-respiratory symptomatic group (28.3±17.9, p = 0.013). One hundred twenty-five patients following the Stretta procedure (n = 60, 31 with respiratory symptoms) or LTF (n = 65, 35 with respiratory symptoms) completed the designated 3-year follow-up period and were included in the final analysis. The symptom scores after anti-reflux therapy all decreased relative to the corresponding baseline values (p<0.05), and there were no significant differences in the control of respiration between the Stretta procedure and LTF (p>0.05). However, LTF significantly reduced the recurrence (re-operation) rate compared with the Stretta procedure (0 vs. 19.4%, p = 0.006).ConclusionsMII-pH monitoring effectively detected respiratory-related predictive parameters, including total/proximal reflux episodes and symptom correlations. We found that GERD patients with respiratory symptoms exhibited more proximal and total reflux episodes but not more acid-related episodes, as determined by MII-pH monitoring. Thus, such monitoring could be useful for diagnosing atypical GERD patients with respiratory symptoms. Furthermore, LTF exhibited a more significant effect on controlling typical symptoms in all GERD patients and reducing the recurrence rate than the Stretta procedure in patients with respiratory symptoms.

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Early and Midterm Outcome After Laparoscopic Fundoplication and a Minimally Invasive Endoscopic Procedure in Patients with Gastroesophageal Reflux Disease: A Prospective Observational Study

Abstract: LTF and the Stretta procedure were equally effective in controlling GERD symptoms and reducing PPI use. However, LTF can achieve more improvement on typical symptoms and has a lower rate of re-operation.

Cited by 26 publications

References 12 publications

Respiratory symptoms, sleep-disordered breathing and biomarkers in nocturnal gastroesophageal reflux

Respiratory symptoms, sleep-disordered breathing and biomarkers in nocturnal gastroesophageal reflux

Laparoscopic Nissen (total) versus anterior 180° fundoplication for gastro-esophageal reflux disease

Diagnosis and Anti-Reflux Therapy for GERD with Respiratory Symptoms: A Study Using Multichannel Intraluminal Impedance-pH Monitoring

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