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THE PARTICIPATION OF SURGEONS IN DIAGNOSTIC WORKUP OF GASTROESOPHAGEAL REFLUX DISEASE INCREASES UTILIZATION OF ANTI-REFLUX SURGERY.

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.

Table 1

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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