Response of atypical symptoms of gastro-oesophageal reflux to antireflux surgery

Farrell, Timothy M.; Richardson, William; Trus, T. L.; Smith, C. Daniel; Hunter, John G.

doi:10.1046/j.0007-1323.2001.01949.x

Cited by 81 publications

(44 citation statements)

References 25 publications

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“…The long-term amelioration of supraesophageal symptoms after a LNF in our study was found in 61% of the patients and only 8% of the patients suffered from difficult or severe cough or hoarseness comparing favorably to some other reported results [12,26]. The symptomatic outcome of patients in this study supports the more promising results of other studies on patients with extraesophageal symptoms as the main indication for LNF [16,18,27,28,29].…”

Section: Discussionsupporting

confidence: 81%

Long-Term Outcomes after Laparoscopic Nissen Fundoplication for Reflux Laryngitis

Karvonen

Ovaska

2010

Dig Surg

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Background: The surgical treatment of gastroesophageal reflux-induced reflux laryngitis remains controversial. The aim of this study was to determine both long-term objective endoscopic findings and subjective symptomatic outcomes after laparoscopic Nissen fundoplication in patients operated on for reflux laryngitis. Methods: 40 consecutive patients with pH-proven reflux laryngitis underwent laparoscopic Nissen fundoplication between 1998 and 2002. 68% (n = 27) of these patients underwent an endoscopic evaluation and 90% (n = 36) were available for the subjective long-term outcome (personal interviews). Results: At a median follow-up of 91 months there were no disrupted plications, none of the patients had esophagitis but 3 recurrent hiatal hernias were detected. 61% of the patients reported no or only mild reflux laryngitis symptoms postoperatively and 69% of the patients evaluated their voice quality improved after surgery. 94% of the patients were satisfied with their surgical result. With benefit of hindsight, 11% of the patients would not choose surgical treatment and 42% had reinitiated antireflux medications postoperatively. Conclusion: The majority of pH-proven gastroesophageal reflux-induced reflux laryngitis patients attain long-term symptomatic benefit and satisfaction on the surgical outcome, and with proper patient selection laparoscopic Nissen fundoplication provides a feasible long-term treatment option for reflux laryngitis.

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Section: Discussionsupporting

confidence: 81%

Long-Term Outcomes after Laparoscopic Nissen Fundoplication for Reflux Laryngitis

Karvonen

Ovaska

2010

Dig Surg

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“…The same holds true for extra-esophageal manifestations which are less responsive to ARS than typical symptoms ( fig. 7) [99].…”

Section: Long-term Managementmentioning

confidence: 99%

“…Outcome of heartburn and extra-esophageal symptoms after anti-reflux surgery. Adapted from Farrell et al [99].…”

Section: Long-term Managementmentioning

confidence: 99%

Treatment of Gastroesophageal Reflux Disease in Adults: An Individualized Approach

Galmiche

Stephenson²

2004

Dig Dis

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Until the 1990s, most therapeutic trials in gastroesophageal reflux disease (GERD) focussed upon endoscopic lesions. In fact the correlation between patient symptoms and both the presence and grade of esophagitis is very poor. The classical criteria for the assessment of therapeutic efficacy in GERD have therefore been revised, and there is now a consensus that the relief of symptoms and the long-term control of the disease are the primary aims of therapy for the majority of patients. Proton pump inhibitors (PPIs) represent the mainstay of therapy for patients with non-erosive reflux disease (NERD) as well as esophagitis. Although a stepwise strategy has been recommended in the past, a step-down strategy (starting with a full-dose PPI) appears to be a more cost-effective approach. There are as yet insufficient data to establish the clear superiority of one PPI over others. PPIs have a number of limitations. Symptom relief is significantly inferior in NERD than in erosive esophagitis. The heterogeneity of the NERD group may be one of the most influential factors, but the role of esophageal hypersensitivity has been suggested especially in patients with normal acid exposure. The role of non-acid reflux should also be scrutinized. Long-term control of the disease can be achieved by drug therapy, anti-reflux surgery and now with a variety of endoscopic procedures. The different drug management strategies can be divided into (i) continuous maintenance therapy and (ii) discontinuous therapy which can again be divided into two categories, intermittent and on-demand drug therapy. A case-by-case approach is recommended to determine the personal therapeutic needs and preferences of each individual. Many patients with NERD or mild esophagitis do not require continuous maintenance therapy and recent studies have shown excellent results with different PPI on-demand therapy regimens. Finally when making a choice between different long-term strategies both the clinician and the informed patient have to consider efficacy, safety, tolerability and cost. The potential efficacy of new drugs, especially the GABA(B) agonists and the fast onset acid suppressors, as well as the cost-effectiveness of non-drug strategies (surgery and endoluminal therapies) should be further evaluated.

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“…LARS prevents vocal fold chemical irritation caused by the blockage of acidic reflux which is thought to accelerate the decreases in erythema/hyperemia and subglottic and vocal fold edema, which is relatively reversible [25][26][27]. The reversible mucosal change may also promote improvement of the voice symptom-related (RSI, VHI-10) and GRBAS scale scores.…”

Section: Discussionmentioning

confidence: 93%

“…So et al found a 93 % improvement in the typical complaints of GERD following fundoplication, but only a 56 % improvement for atypical complaints [24]. Farrel et al found postsurgical improvement in 99 %, with complete resolution in 87 % of patients with predominant symptoms of GERD, and 93 % and 48 % improvement and resolution for patients in whom LPR symptoms were predominant [25]. In our study, the rate of regression of atypical symptoms was lower: globus and throat clearing in 23.1 %, irritating cough in 12.3 %.…”

Section: Discussionmentioning

confidence: 95%

The effect of antireflux surgery on laryngeal symptoms, findings and voice parameters

Şahin

Vardar

Ersin

et al. 2015

Eur Arch Otorhinolaryngol

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The aim of this study was to evaluate the effect of laparoscopic antireflux surgery (LARS) on the laryngeal symptoms, physical findings and voice parameters of gastroesophageal reflux disease (GERD) patients with or without laryngopharyngeal reflux (LPR). Forty-one GERD patients predominantly with LPR symptoms (Group I) and twenty-six GERD patients without LPR symptoms (Group II) who had LARS were prospectively analysed before and 2 years after the surgery. Upper gastrointestinal endoscopy, 24-h ambulatory pH or MII-pH monitoring was performed in all cases. A reflux study group including specialists from five departments in a university hospital decided surgical indications. Patients were asked to fill out a validated LPR and voice quality questionnaire (Reflux Symptom Index and Voice Handicap Index-10). Laryngeal findings were evaluated and scored using a laryngoscopic grading scale [Reflux Finding Score (RFS)], by four blinded ENT specialists. GRBAS scale was done by a blinded otolaryngologist. Voice parameters were measured objectively via the Multi Dimensional Voice Programme (MDVP). The mean age was 45.8 ± 8.5 for Group I (24 men) and 48.9 ± 12.3 for Group II (16 men). The mean follow-up after LARS was 24.5 ± 1.3 months for Group I and 25.2 ± 1.1 months for Group II. The preoperative mean score of RSI was 22.8 ± 7.4 vs. 11.2 ± 6.6; RFS was 10.6 ± 2.3 vs. 5.7 ± 2.5 and VHI was 18.07 ± 4.4 vs. 10.86 ± 3.3 for Group I and II, respectively. The postoperative mean score of RSI was 12.9 ± 6.4 vs. 8.4 ± 4.5; RFS was 6.9 ± 2.0 vs. 4.5 ± 2.3 and VHI was 9.59 ± 4.4 vs. 7.95 ± 3.5 for Group I and II, respectively. Group I had significantly lower RSI and RFS scores following LARS compared to the preoperative scores. LARS successfully improved RFS, RSI and VHI in carefully selected patients with GERD, especially the signs and symptoms related to the larynx and voice. Although the indications for LARS are limited in patients with LPR symptoms, these results favor the decision-making period of LARS.

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Response of atypical symptoms of gastro-oesophageal reflux to antireflux surgery

Abstract: Atypical symptoms of GOR are improved by fundoplication, but symptom resolution occurs in fewer than 50 per cent of patients.

Cited by 81 publications

References 25 publications

Long-Term Outcomes after Laparoscopic Nissen Fundoplication for Reflux Laryngitis

Long-Term Outcomes after Laparoscopic Nissen Fundoplication for Reflux Laryngitis

Treatment of Gastroesophageal Reflux Disease in Adults: An Individualized Approach

The effect of antireflux surgery on laryngeal symptoms, findings and voice parameters

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