Efficacy of laparoscopic anti-reflux surgery for non-erosive gastroesophageal reflux disease assessed by combined multichannel intraluminal impedance-pH monitoring

Fumiaki Yano, Nobuo Omura, Kazuto Tsuboi, Masato Hoshino, Se Ryung Yamamoto, Shunsuke Akimoto, Takahiro Masuda, Koji Nakada, Katsunori Nishikawa, Norio Mitsumori, Hideyuki Kashiwagi, Katsuhiko Yanaga. Department of Surgery, The Jikei University School of Medicine

INTRODUCTION: Due to the high prevalence of PPI resistance, treatment of non-erosive gastroesophageal reflux disease (NERD) is challenging as compared to gastroesophageal reflux disease with reflux esophagitis (GERD). The aim of this study was to investigate the therapeutic effects of laparoscopic anti-reflux surgery (LARS) for NERD using 24-h combined multichannel intraluminal impedance-pH monitoring (MII-pH).

METHODS AND PROCEDURES: Between February 2009 and August 2015, 30 patients (mean age, 48.5 years, 11 women) who underwent LARS for NERD underwent MII-pH monitoring before and at 3 months after surgery. Reflux events were classified by pH as acid or non-acid reflux. Intraesophageal pH<4 holding time (pH<4), longest episode, episodes over 5 min, DeMeester score, and the numbers of acid and non-acid reflux episodes were calculated with the patient in both liquid and gas reflux. The symptom index (SI) and symptom association probability (SAP) were also evaluated.

RESULTS: Twenty-six patients (87%) had hiatal hernia. The results of reflux events were listed on the table. The liquid pooling in the esophagus after surgery was possibly detected as non-acid gastroesophageal reflux. Both SI and SAP improved significantly after surgery (p=0.011, 0.005).

CONCLUSIONS: 1) LARS for NERD completely controlled all acid reflux events and patients’ symptoms. 2) As unidentified complaints after surgery, liquid pooling in the esophagus could be detected as non-acid gastroesophageal reflux.

 

Table

  pH<4HT

LE

> 5 min

DM

LAR

LNAR

GAR

GNAR

TR

pre

3.8±4.9

11.5±15.1

2.0±3.0

13.5±15.9

32.6±25.9

34.4±27.2

3.8±8.2

15.6±17.8

83.2±51.2

post

0.5±1.1

1.8±3.7 0.2±0.7

2.4±4.0

8.3±14.9 27.1±25.6 0.8±1.2 12.5±11.2 48.4±38.2

p-value

<0.001

<0.001

0.004

<0.001

<0.001

0.121 0.04 0.445 <0.001

                                                                                                     mean±S.D.

pH<4HT; pH<4 holding time (%), LT; Longest episode (min), > 5 min; episode over 5 min., DM; DeMeester score, LAR/LNAR; Liquid acid reflux/non-acid reflux,GAR/GNAR; Gas acid reflux/non-acid reflux, TR; Total reflux

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