Clinical outcome after laparoscopic Nissen fundoplication in patients with GERD and PPI refractory heartburn
Clinical outcome after laparoscopic Nissen fundoplication in patients with GERD and PPI refractory heartburn
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DOI：
10.1093/dote/doz099
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发表时间：
2020-04-01
影响因子：
2.6
通讯作者：
DeMeester, Steven R.
中科院分区：
文献类型：
--
作者：
Schwameis, Katrin;Oh, Daniel;DeMeester, Steven R.
对质子泵抑制剂（PPI）治疗反应良好的典型反流症状是预测胃食管反流病（GERD）抗反流手术结局良好的关键因素。我们的目的是评估PPI对术前胃灼热（HB）缓解不佳是否与Nissen胃底折叠术后的不良结局相关。纳入了2008年1月至2014年12月期间接受腹腔镜Nissen胃底折叠术的HB主要症状和pH检测阳性的患者。手术前，患者对PPI缓解HB症状的有效性进行分级。分为三组：良好反应（76-100%缓解）、部分反应（26-75%缓解）和不良反应（0-25%缓解）。在胃底折叠术后至少1年评估结果和满意度。有129名患者符合入选标准，75名同意参加。中位随访时间为48个月。在Nissen胃底折叠术之前，13例患者对PPI治疗有良好的HB反应，36例有部分反应，26例反应较差。所有患者均对胃底折叠术后HB缓解感到满意（平均满意度评分：9.5/10），组间满意度评分或胃灼热缓解无差异。在客观证实的GERD患者中，对PPI治疗反应不佳的烧心症状可通过尼森胃底折叠术可靠缓解。Nissen胃底折叠术后患者满意度极佳，术前PPI治疗的HB缓解较差与极佳患者的满意度相似。因此，无论PPI药物对HB症状的缓解程度如何，抗反流手术都是HB和确诊GERD患者的一种选择。
Typical reflux symptoms that respond well to proton pump inhibitor (PPI) therapy are key factors predictive of an excellent outcome with antireflux surgery for gastroesophageal reflux disease (GERD). Our aim was to evaluate whether poor preoperative heartburn (HB) relief with PPIs was associated with a worse outcome after Nissen fundoplication. Patients with a main symptom of HB and a positive pH-test who had a laparoscopic Nissen fundoplication between January 2008 and December 2014 were included. Prior to surgery, patients graded how effectively their HB symptoms were relieved by PPIs. Three groups were defined: good response (76-100% relief), partial response (26-75% relief) and poor response (0-25% relief). Outcomes and satisfaction were assessed at a minimum of 1 year after fundoplication. There were 129 patients who met inclusion criteria and 75 agreed to participate. The median follow-up was 48 months. Prior to Nissen fundoplication 13 patients had a good HB response to PPI-therapy, 36 had a partial response and 26 had a poor response. All patients were satisfied with their HB relief after fundoplication (mean satisfaction score: 9.5/10) and there was no difference in satisfaction score or heartburn relief between groups. Heartburn symptoms that respond poorly to PPI therapy are reliably relieved with a Nissen fundoplication in patients with objectively confirmed GERD. Patient satisfaction after Nissen fundoplication was excellent and was similar in patients with poor versus excellent HB relief with preoperative PPI therapy. Therefore, antireflux surgery is an option for patients with HB and confirmed GERD regardless of the degree of relief of HB symptoms provided by PPI medications.