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Journal of Gastrointestinal Surgery

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01-09-2014 | Original Article

Outcome of Laparoscopic Nissen Fundoplication for Gastroesophageal Reflux Disease in Non-responders to Proton Pump Inhibitors

Authors: Emad Hamdy, Ayman El Nakeeb, Hosam Hamed, Mohamed El Hemaly, Nabil Gad ElHak

Published in: Journal of Gastrointestinal Surgery | Issue 9/2014

Abstract

Background

Gastroesophageal reflux disease (GERD) is a common public health problem. Medical treatment remains the first line of treatment of GERD. Failure of medical treatment may occur in up to 45 % of GERD patients. This study aims to evaluate the outcome of laparoscopic Nissen fundoplication (LNF) as a means of antireflux surgery in patients with poor response to anti-reflux medication.

Patients and Methods

This is a prospective study of patients who underwent LNF in the period between January 2000 and December 2010 in the Gastrointestinal Surgical Center, Mansoura University, Egypt. Patients were assessed preoperatively and postoperatively, after 1 year, by clinical examination, esophagogastroscope, barium esophagography, esophageal manometry and 24-h pH monitoring. Patient satisfaction after surgery was also graded through a questionnaire.

Results

The study population was 370 patients. 296 patients were good responders to proton pump inhibitors (PPI) while 74 patients were PPI non-responders. Preoperatively, atypical reflux symptoms were significantly more in PPI non-responders (P = 0.006). On follow-up, PPI responders significantly reported relief of heartburn (P = 0.01) and regurgitation (P = 0.04). Patient satisfaction was more in PPI responders (P = 0.04). Both groups were comparable regarding anatomical and functional assessment. Integrity of the wrap was higher in PPI responders (P = 0.04).

Conclusion

PPI non-responders should not be precluded from LNF. Thorough assessment is mandatory to confirm GERD diagnosis. A substantial proportion of PPI failures show good response to LNF but significantly than clinical response in PPI responders. Increased likelihood of poor outcome after surgery should be discussed with the patient.

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Title: Outcome of Laparoscopic Nissen Fundoplication for Gastroesophageal Reflux Disease in Non-responders to Proton Pump Inhibitors
Authors: Emad Hamdy
Ayman El Nakeeb
Hosam Hamed
Mohamed El Hemaly
Nabil Gad ElHak
Publication date: 01-09-2014
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 9/2014
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-014-2584-3

At a glance: The STEP trials

Springer Medicine

Outcome of Laparoscopic Nissen Fundoplication for Gastroesophageal Reflux Disease in Non-responders to Proton Pump Inhibitors

Abstract

Background

Patients and Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Patients and Methods

Results

Conclusion

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