Carla N Holcomb, MD, MSPH, Anahita Jalilvand, MD, Patricia Belle, Monet Mcnally, Kyle Perry, MD. Ohio State University Medical Center
Introduction: Anxiety and depression have been associated with increased perception of gastroesophageal reflux, but there is a paucity of data regarding the outcomes of laparoscopic anti-reflux surgery in this patient population. We hypothesized that the presence of these disorders does not impact symptomatic outcomes of laparoscopic Nissen fundoplication (LNF) and tested this hypothesis in a single-institution retrospective cohort study of patients undergoing elective LNF.
Methods: We performed a retrospective review of all patients undergoing LNF between 2011 and 2016. Demographic, preoperative, operative and outcome data were collected and maintained in an IRB approved database. Patients were stratified by baseline usage of either a serotonin-modulating medication (SMM) or benzodiazepines (BZM), as a proxy for depression and anxiety disorders. The primary outcome measure was post-operative gastroesophageal health related quality of life (GERD-HRQL )scores. Analyses were carried out using Mann-Whitney U, Chi2, or Fisher’s Exact, as appropriate; a p value of <0.05 was considered statistically significant.
Results: The population consisted on 271 patients, of which 16% were taking a BZM(n=44) and 38% were taking a SMM(n=103). Compared to those not on any psychotropic medications, patients on BZM reported significantly higher baseline HRQL scores (34 [25-41] vs 29[18-36],p=0.03) despite no significant preoperative differences in motility or pH testing. Median follow-up time was 4 weeks in all groups. At postoperative follow-up visits, patients taking a BZM reported similar HRQL scores to controls (4[1-8) vs 3(1-8), p=0.74). For patients taking SMM, there were no significant differences in baseline HRQL scores, preoperative testing or postoperative HRQL scores compared to those not on any psychotropic medications.
Conclusion: Patients who take benzodiazepines have higher subjective reporting of GERD symptoms at baseline despite similar objective data compared to those who do not. However, after anti-reflux surgery the subjective outcomes are similar in both groups. Serotonin modulating medication use does not appear to effect subjective reporting of GERD symptoms. Although anxiety may increase the severity of the perception of GERD, surgery seems to produce the same benefit as it does to patients without anxiety at short-term follow-up. Further studies are needed to test the effect of the long term benefit of anti-reflux surgery in this population.
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Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95431
Program Number: S024
Presentation Session: Foregut I
Presentation Type: Podium