Nissen fundoplicationvsproton pump inhibitors for laryngopharyngeal reflux based on pH-monitoring and symptom-scale

Abstract

AIMTo compare the outcomes between laparoscopic Nissen fundoplication (LNF) and proton pump inhibitors (PPIs) therapy in patients with laryngopharyngeal reflux (LPR) and type I hiatal hernia diagnosed by oropharyngeal pH-monitoring and symptom-scale assessment.METHODSFrom February 2014 to January 2015, 70 patients who were diagnosed with LPR and type I hiatal hernia and referred for symptomatic assessment, oropharyngeal pH-monitoring, manometry, and gastrointestinal endoscopy were enrolled in this study. All of the patients met the inclusion criteria. All of the patients underwent LNF or PPIs administration, and completed a 2-year follow-up. Patients’ baseline characteristics and primary outcome measures, including comprehensive and single symptoms of LPR, PPIs independence, and satisfaction, and postoperative complications were assessed. The outcomes of LNF and PPIs therapy were analyzed and compared.RESULTSThere were 31 patients in the LNF group and 39 patients in the PPI group. Fifty-three patients (25 in the LNF group and 28 in the PPI group) completed reviews and follow-up. Oropharyngeal pH-monitoring parameters were all abnormal with high acid exposure, a large amount of reflux, and a high Ryan score, associated reflux symptom index (RSI) score. There was a significant improvement in the RSI and LPR symptom scores after the 2-year follow-up in both groups (P < 0.05), as well as typical symptoms of gastroesophageal reflux disease. Improvement in the RSI (P < 0.005) and symptom scores of cough (P = 0.032), mucus (P = 0.011), and throat clearing (P = 0.022) was significantly superior in the LNF group to that in the PPI group. After LNF and PPIs therapy, 13 and 53 patients achieved independence from PPIs therapy (LNF: 44.0% vs PPI: 7.14%, P < 0.001) during follow-up, respectively. Patients in the LNF group were more satisfied with their quality of life than those in the PPI group (LNF: 62.49 ± 28.68 vs PPI: 44.36 ± 32.77, P = 0.004). Body mass index was significantly lower in the LNF group than in the PPI group (LNF: 22.2 ± 3.1 kg/m2 vs PPI: 25.1 ± 2.9 kg/m2, P = 0.001).CONCLUSIONDiagnosis of LPR should be assessed with oropharyngeal pH-monitoring, manometry, and the symptom-scale. LNF achieves better improvement than PPIs for LPR with type I hiatal hernia.

Evidence-Based Practice Guideline for Surgical Treatment of Gastroesophageal Reflux Disease 2018

“…Comparing the 25 patients in the anti-reflux surgery group and 28 patients in the PPI group with extraesophageal manifestations, improvements in RSI score (P<0.005) and symptom scores of cough (P=0.032), mucus (P=0.011), and throat clearing (P=0.022) were significantly superior in the surgery group to those in the PPI group [9]. A systemic review and meta-analysis pooled data from 21 reports and reported GERD-related chronic laryngitis patients.…”

“…The prevalence of GERD reached 7.3% in 2008, with a mean annual increase of 15.3% in Korea [4]. In Western countries, GERD is typically treated with a proton pump inhibitor (PPI) and fundoplication [567891011]. Despite numerous studies reporting the effectiveness of surgical treatment, medication-oriented treatment remains the mainstay because of a lack of awareness of surgical treatment in Korea.…”

Risk of GERD-Related Disorders in Obese Patients on PPI Therapy: a Population Analysis

“…Gastric fundoplication is effective in significantly reducing acid reflux in an obese cohort [ 23 ]. It provides improved resolution of reflux compared to PPI therapy for GERD with or without an associated hiatus hernia [ 24 , 25 ]. Gastric bypass operations for morbid obesity have also been shown to reduce acid reflux, in addition to reducing BMI and metabolic conditions [ 26 ].…”

Proximal reflux: biochemical mediators, markers, therapeutic targets, and clinical correlations

“…94 More recent studies confirm those findings. [95][96][97] A review of the surgical treatment for patients with chronic cough, LPR, and asthma found a surgical FP success rate between 48% and 94%. 98 The same group published a more recent review; according to a weighted mean per study per patient then compiled, 83.0% of patients (95% CI: 79.7-86.3%) experienced improvement, and 67.0% of patients (95% CI: 64.1-69.9%) experienced a resolution of symptoms.…”