Elizabeth A Miller, MD(*); R A Bright, MD; S C Springmeyer, MD and D E Low, MD. Virginia Mason Medical Center, Seattle, WA.
PURPOSE: Many patients with gastroesophageal reflux disease (GERD) will have coexistent respiratory symptoms including recurrent infection, cough, asthma, hoarseness, and sore throat. It remains unclear what percentage of patients with respiratory symptoms will improve following surgical control of GERD.
METHODS: Over nine years (1991-99), 82 patients with GERD and respiratory symptoms underwent antireflux operations. All patients were reviewed in clinic and with subsequent telephone questionnaire (mean follow-up 38 months) to assess response of GERD and respiratory symptoms.
RESULTS: Preoperatively, all reported reflux symptoms refractory to conventional medical treatment and most (70%) had additional complications of GERD: aspiration (36%), Barrett's metaplasia (25%), and stricture (9%). Preoperative respiratory symptoms included cough (75%), hoarseness (42%), asthma (33%), recurrent infection (19%), and sore throat (3%). Respiratory symptoms required medical therapy in 75%, including 18% of patients who could not be weaned from steroids. Preoperative investigations included endoscopy, esophageal manometry, and 24-hour esophageal pH monitor. Mean 24-hour pH studies demonstrated abnormal levels of esophageal acid exposure in the total, supine, and upright positions. Most (94%) of the antirefiux operations were primary and performed as open procedures. Symptom responses following surgical treatment were: GERD (98%), recurrent infection (82%), hoarseness (72%), asthma (66%), cough (64%), and sore throat (33%). The need for GERD medications was eliminated in 85%. Respiratory medications were decreased or eliminated in 33% including 13 of 14 asthma patients who were able to discontinue steroids. QOL significantly improved postoperatively.
CONCLUSION: This series suggests that a significant percentage of patients with refractory respiratory problems and co-existing GERD will benefit from antireflux surgery.
CLINICAL IMPLICATIONS: Patients with GERD and refractory respiratory problems should be considered for antireflux surgery.
COPYRIGHT 2000 American College of Chest Physicians
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