Alex Addo, MD, Zachary Sanford, MD, Adam S Weltz, MD, James Clemmens, Reza Zahiri, DO, Adrian Park, MD, FACS. Anne Arundel Medical Center
Introduction: The Johnson-DeMeester (JD) score is one of the main parameters derived from pH testing as a means to determine a patient’s acid exposure and is often used as an objective data point to determine potential need for anti-reflux surgery. The purpose of this study was to determine if a normal JD score alone is sufficient to preclude patients from consideration for laparoscopic anti-reflux surgery (LARS).
Methods: A retrospective study was conducted to review quality of life (QOL) outcomes after LARS in patients with a normal (<14.7) versus abnormal (≥14.7) JD score at a high volume foregut disorder center between October 2012 and April 2018. [AW1] Patient QOL was assessed using four validated surveys: Reflux Symptoms Index (RSI), GERD Health Related Quality of Life Score (GERD-HRQL), Laryngopharyngeal Reflux-Health Related Quality of Life Instrument (LPR-HRQL), and Swallowing Quality of Life (SWAL). Additional study outcomes included 30-day wound and non-wound related complications, readmission and reoperation rates.
Results: 144 patients with mean follow up of 1.8 years (1 month – 5 years) were selected for this study, 38 (26.4%) with normal and 100 (73.6%) with abnormal JD scores. The two groups had significantly different mean JD scores (7.40 vs 57.64, p< 0.05). Among the normal and abnormal cohorts thirty day wound and non-wound related complications were 0%. All patients derived significant QOL benefits from operative intervention regardless of JD scores with improvements in mean RSI (65%), GERD-HRQL (79%), LPR-HRQOL (77%), and SWAL (19%) surveys through five years [AW2] in greatest follow up (p<0.01). A comparison between the groups did not show any differences in post-operative outcomes and [AW3] percent improvement in QOL outcomes. No patients required reoperation. Patient satisfaction was strong at long term follow up, with both groups reporting either “satisfied” or “neutral” in 94% of cases.
Conclusion: Our findings confirm that the JD score alone does not correlate with QOL outcomes after laparoscopic anti-reflux surgery. Patients with objective diagnosis of GERD despite a normal JD score should not be precluded from consideration for anti-reflux surgery.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95572
Program Number: P496
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster