Surgical outcome in gastro-esophageal reflux disease patients with inadequate response to proton pump inhibitors

Anvari, Mehran; Allen, Christopher

doi:10.1007/s00464-002-8571-x

Cited by 40 publications

(42 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, more than 90% of our poor responders were followed up for at least 6 months. Furthermore, our follow-up figures compare favorably with those of Anvari and Allen [1], and reflect the fact that many patients who undergo LARS simply do not wish to have any further investigations. This applies both to those who have an excellent or good outcome and to those with a fair or poor outcome.…”

Section: Discussionsupporting

confidence: 63%

“…Other groups have supported this view [4]. Conversely, Anvari et al [1] showed that patients with a poor response to PPIs can have a good outcome from surgery. Poor responders had significant improvement in postoperative symptom scores and quality-of-life scores, associated with significant reductions in lower esophageal acid exposure.…”

Section: Discussionmentioning

confidence: 68%

“…They also suggested that the term ''non-acid reflux'' may be a misnomer because bile refluxing into the stomach was acidified before refluxing into the esophagus. However, a number of investigators have advocated the use of multichannel intraluminal impedance (MII) testing to detect non-acid reflux [1,18]. This system uses changes in impedance to detect refluxate within the esophagus and uses pH monitoring (MII-pH) to classify it as acid or nonacid reflux.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

A poor response to proton pump inhibition is not a contraindication for laparoscopic antireflux surgery for gastro esophageal reflux disease

et al. 2005

View full text Add to dashboard Cite

show abstract

Section: Discussionsupporting

confidence: 63%

Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A poor response to proton pump inhibition is not a contraindication for laparoscopic antireflux surgery for gastro esophageal reflux disease

et al. 2005

View full text Add to dashboard Cite

show abstract

“…The late reoperation rate was 1.7% in group 1 and 3.4% in group 2. These percentages are quite similar to results reported in other studies [4,9]. All the patients included in this study underwent a postoperative control visit 6 months after the operation and were interviewed about possible postoperative dysphagia.…”

Section: Discussionmentioning

confidence: 55%

Surgeons’ experience with laparoscopic fundoplication after the early personal experience: does it have an impact on the outcome?

et al. 2007

View full text Add to dashboard Cite

Substantial experience with the procedure is associated with a shorter operating time and somewhat fewer complications, conversions, and early dysphagia episodes. This supports the provision of expert supervision even after the initial learning phase of 20 individual procedures. The patients' long-term subjective symptomatic outcome was similar in the two groups. Substantial experience does not provide better late results than surgical experience beyond the learning curve.

show abstract

“…For patients with moderate obesity (BMI >35 but <40), Anvari and Allen [11] showed good outcomes for Nissen fundoplication with both symptom control and a moderate degree of weight loss. For patients with a BMI >40, gastrojejunal bypass is the preferable route, but requires a cooperative patient.…”

Section: Morbid Obesitymentioning

confidence: 99%

Borderline Indications and Selection of Gastroesophageal Reflux Disease Patients: ‘Is Surgery Better than Medical Therapy'?

Lundell

2014

Dig Dis

View full text Add to dashboard Cite

Modern medical therapies for gastroesophageal reflux disease (GERD) are totally dedicated to the control of the acid component of the refluxate. In chronic erosive GERD, antireflux surgery has proven to be very efficacious and superior to traditional medical therapies, such as H₂ blockers. The introduction of proton pump inhibitors (PPIs), however, substantially improved medical therapy. Still, treatment failures are inevitable regardless of which of these two effective therapies is chosen. Some recent reports have presented conflicting results from trials comparing antireflux surgery and PPIs. This may be due to differences in trial designs as well as in the structure and content of the therapeutic strategies that are compared. The study with the longest clinical follow-up by far is the SOPRAN study comparing open antireflux surgery and omeprazole. The protocol provides for a follow-up period of more than a decade and the clinical outcomes have recently been published. There has always been concern about the long-term effectiveness of reflux prevention whether by surgery or PPI therapy. It is likely that a marker for an emerging risk for recurrence of GERD is abnormal acid reflux as assessed by ambulatory 24-hour pH-metry. The LOTUS trial compared maintenance therapy provided by esomeprazole (dose-adjusted when required) with standardized laparoscopic antireflux surgery in patients with good response to acid suppressive therapy. An operation is suitable when symptoms are poorly controlled despite medication, especially for patients who suffer large-volume regurgitation and those who wake at night coughing and choking and who regurgitate acidic fluid or food into their throat and airways. Regurgitation into the throat upon stooping or exercising can limit a patient's ability to work, play sports or even do simple housework. A few patients cannot tolerate medical treatment. If surgery is to be a good option, it must be ensured that the right surgeon performs a standardized operation for the right indications on the right patient and provides good preoperative counseling and testing along with postoperative support. When a patient is refractory to medical treatment, the diagnosis of GERD should be reconsidered before surgery is advised; extradigestive manifestations should be accounted for with care. Conclusions: Laparoscopic fundoplication (LF) substantially improves GERD symptoms, although in some individuals symptoms return and acid-suppressive medication use increases. Limited data suggest that LF is less effective at reducing symptoms in partial responders to medical therapy than in complete responders. This may affect cost arguments for using fundoplication surgery rather than acid-suppressive medications, as data are based largely on complete responders.

show abstract

Surgical outcome in gastro-esophageal reflux disease patients with inadequate response to proton pump inhibitors

Cited by 40 publications

References 14 publications

A poor response to proton pump inhibition is not a contraindication for laparoscopic antireflux surgery for gastro esophageal reflux disease

A poor response to proton pump inhibition is not a contraindication for laparoscopic antireflux surgery for gastro esophageal reflux disease

Surgeons’ experience with laparoscopic fundoplication after the early personal experience: does it have an impact on the outcome?

Borderline Indications and Selection of Gastroesophageal Reflux Disease Patients: ‘Is Surgery Better than Medical Therapy'?

Contact Info

Product

Resources

About