Medhat Fanous, MD, FACS, Anja Jaehne, MD, David Lorenson, RN, Amanda Lambert, RN, Sarah Williams, RN. Aspirus Health System
Introduction: Patients presenting with putative symptoms of gastroesophageal reflux disease (GERD) are usually evaluated by gastroenterologists who perform the diagnostic workup and determine when to refer for surgical consideration. The multiple diagnostic studies can be overwhelming and leads to dropouts. In rural setting, without gastroenterology services, the surgeon can diagnose and perform surgical interventions. The aim of this study is to assess the completion of the required diagnostic studies and progression to surgical intervention.
Methods: This is a retrospective chart review of patients who presented with GERD symptoms between August 2015 and January 2018. Standardized workup included upper gastrointestinal study (UGI) and esophagogastroduodenoscopy (EGD) with concomitant wireless pH placement. High resolution impedance manometry was selectively offered to patients who reported dysphagia or had evidence of esophageal dysmotility on UGI.
Results: 429 patients were evaluated. Their data is listed in table 1. Proton pump inhibitors were used by 82.2% of patients. Required diagnostic workup was completed by 92.7 % of all patients. Nearly 75% were suitable candidates for anti-reflux surgery. Approximately 2/3 of these patients proceeded with anti-reflux surgery.
Conclusion: Surgical anti-reflux program with diagnostic and therapeutic capabilities results in high rate of completion of diagnostic workup and increase in utilization of anti-reflux surgery.
|
Demographics Female : Male Age (years) BMI |
283 : 146 58.1 ± 15 30.6 ± 6.5 |
|
Symptoms Duration (years) Classic Extraesophageal Both |
14.9 ± 12.2 60/429 (13.9%) 14/429 (3.3%) 355/429 (82.8%) |
|
Anti-secretory medicine PPIs -Duration of PPIs (years) -Daily use of PPIs -BID use of PPIs -combination with H2 blockers |
353 /429 (82.2%) 11 ± 9 249/432 (57.5%) 104/432 (24.0%) 84/432 (19.3%) |
|
GERD questionnaires (on PPIs) GERD- health related quality of life (HRQL) Heartburn score Regurgitation score Reflux Symptom index (RSI) GERD symptom score (GERSS) |
32.7±18.2 14±8.1 11.8±8.4 24.8± 12.7 23.5±14.4 |
|
Diagnostic studies Not completed Completed |
31/429 (7.3%) 398/429 (92.7%) |
|
Surgical candidacy Not a candidate Candidate -proceed with anti-reflux surgery -continue medical therapy |
100/398 (25.2%) 298/398 (74.8%) 194/298 (65.2%) 104/298 (34.8%) |
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 92066
Program Number: P454
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster
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