Antireflux surgery in patients with normal preoperative 24-hour pH

Patients with gastroesophageal reflux disease and normal preoperative 24-hour pH test results have significantly worse outcomes after Nissen fundoplication, find researchers in the American Journal of Surgery.

Preoperative 24-hour pH testing is controversial in surgical patients who have symptomatic gastroesophageal reflux disease (GERD) and endoscopic evidence of esophagitis.

In this study, researchers from Portland, Oregon, compared the clinical outcomes of Nissen fundoplication for symptomatic reflux in patients with normal and abnormal preoperative pH testing.

The team included 223 patients who underwent laparoscopic esophageal procedures between 1997 and 2001.

All patients had typical symptoms of GERD, preoperative pH testing, manometry, and endoscopy. They also had 6 months worth of follow-p data available.

Overall, 15 patients had normal preoperative DeMeester scores (DMS). The remaining 208 patients had abnormal preoperative DMS.

The researchers found that there were no significant differences in demographics, preoperative symptom score or preoperative grade of esophagitis between the 2 groups.

Median follow-up was 8.8 months. After follow-up 40% of the normal DMS group and 8% of the abnormal DMS continued to have typical GERD symptoms.

The most team determined that normal preoperative pH was associated with poor outcome (odds ratio 9.02).

Dr Yashodhan's team concluded, "Symptomatic GERD patients with normal preoperative 24-hour pH test results have significantly worse subjective outcomes after Nissen fundoplication compared with patients having abnormal preoperative pH test results".

"To minimize poor symptomatic outcomes after antireflux surgery, a policy of routine preoperative pH testing is advised".