False-positive symptoms of recurrence of gastroesophageal reflux disease (gerd) in patients with hiatal hernia (hh) after anti-reflux videolaparoscopy

Abstract

We compared the results of remote survey of 213 patients with HH associated with GERD in the long term after anti-reflux videolaparoscopy, according to the GERD-HRQL, GIQLI, and SF-36 questionnaires (patients’ complaints) and special methods for studying the anti-reflux function of the cardia (X-ray endoscopy of the esophagus and stomach, daily esophageal pH monitoring, esophageal manometry). Based on the results of special studies, a generalized indicator of failure of the anti-reflux function of the cardia (GIFAFC) was developed. It was found that 57.3% of the examined patients had false-positive symptoms of GERD recurrence, which was manifested by pain in the epigastric region (31.2%), belching with air (4.1%), and heartburn (21.3%). There were no symptoms when bent over or lying down. The existing symptoms were mild, easily stopped by conservative treatment. The patients with false-positive GERD symptoms after surgery showed an improvement in GIFAFC by 7.9 times (p <0.001), but it was 5.4 times worse than in patients without recurrent GERD (p <0.001), and 6.3 times better in relation to patients with recurrent GERD (p<0.05). False-positive symptoms of GERD recurrence contributed to a decrease in the generalized indicator of quality of life, which, according to the SF-36 questionnaire, was 76% of the maximum desired result. Due to the absence of reliable clinical manifestations, all patients with HH who have certain symptoms of GERD after fundoplication should undergo an instrumental study of the anti-reflux function of the cardia. Patients with established false-positive symptoms of GERD are subject to dispensary follow-up.