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|Title:||Recurrent heartburn after Laparoscopic Fundoplication is not always recurrent reflux|
|Citation:||Journal of Gastrointestinal Surgery, 2007; 11(5):642-647|
|Publisher:||Elsevier Svience Inc|
|Sarah K. Thompson, Glyn G. Jamieson, Jennifer C. Myers, Kin-Fah Chin, David I. Watson and Peter G. Devitt|
|Abstract:||Introduction: A small cohort of patients present after antireflux surgery complaining of recurrent heartburn. Many of these patients have been empirically recommenced on proton pump inhibitors. Objective: The aim of this study was to determine whether patients with symptoms that suggest recurrent reflux had objective evidence of reflux, and to determine predictors of recurrent reflux. Methods: We identified all patients from an existing database who had undergone pH monitoring for “recurrent heartburn” after fundoplication. These patients were then cross-referenced to another database, which recorded the outcomes for patients who had undergone a laparoscopic fundoplication. Patients complaining of dysphagia or other problems without heartburn were excluded from analysis. Results: Seventy-six patients were identified who met the inclusion criteria. Fifty-six (74%) of these had a normal 24-h pH study. Thirty-five patients (63%) with a normal pH study were on medication for heartburn at the time of referral. Three factors were found to be associated with an abnormal 24-h pH study: a partial fundoplication (P = 0.039), onset of symptoms 6 months or more after surgery (P < 0.001), and a good symptom response when antireflux medication was recommenced (P = 0.015). Conclusions Not all patients complaining of recurrent heartburn after fundoplication have evidence of abnormal reflux. Objective evidence of abnormal esophageal acid exposure should be confirmed before recommencing antireflux medication.|
|Keywords:||Laparoscopic fundoplication; Recurrent heartburn; Recurrent reflux; 24-h pH study|
|Description:||Presented at the 10th World Congress of the International Society for Diseases of the Esophagus (ISDE), Adelaide Convention Center, South Australia, Australia, February 24, 2006|
|Appears in Collections:||Surgery publications|
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