Antireflux surgery in patients with gastroesophageal reflux but a negative 24-hour pH study - late outcomes
Abstract
PURPOSE
Patients with gastroesophageal reflux disease often undergo a 24hrpH test to confirm pathological reflux before undergoing surgery. However, a negative pH test can occur in some individuals with reflux, and a case might still be made for antireflux surgery based on symptoms of reflux even in the absence of endoscopic oesophagitis. The long-term outcomes in patients who underwent antireflux surgery despite negative preoperative test results were determined.
METHODS
Patients were selected from a prospective database. 745 patients met the inclusion criteria; typical esophageal reflux symptoms, absence of a large hiatus hernia, pre-operative 24-hour pH study performed, endoscopy, and post-operative symptom and satisfaction follow up available at 5 years. Patients were divided into 3 groups based on 24hrpH study and endoscopy results; negative pH & negative endoscopy (n=65); negative pH & positive endoscopy (n=72); and positive pH (n=608) controls. The negative pH and endoscopy group underwent surgery based on clinical assessment and typical esophageal reflux symptoms. Baseline and follow-up outcomes at 5 years were evaluated using 0-10 analog scores which assessed heartburn, dysphagia and satisfaction with the overall outcome. Data were analyzed to compare the groups.
RESULTS
Groups were well matched for demographics and preoperative symptom scores. At median 5 year follow-up, clinical outcome scores were similar between groups for heartburn, dysphagia, and overall…
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