PMID- 17163371
OWN - NLM
STAT- MEDLINE
DCOM- 20070228
LR  - 20131121
IS  - 0044-2771 (Print)
IS  - 0044-2771 (Linking)
VI  - 44
IP  - 12
DP  - 2006 Dec
TI  - [Anti-reflux surgery in patients with adequate response to proton pump inhibitors 
      - is there an indication?].
PG  - 1217-22
AB  - BACKGROUND: The indication for anti-reflux-surgery in patients with 
      gastroesophageal reflux disease (GERD) who are totally symptom-free under 
      conservative treatment with proton pump inhibitors (PPI) is still seen 
      controversially. Arguments for PPI-treatment include the missing trauma and few 
      side-effects, arguments against include the life-time-long drug intake. We 
      prospectively observed the indication of anti-reflux-surgery in symptom-free 
      patients in comparison to patients with remaining symptoms under treatment with 
      PPI. PATIENTS AND METHODS: Between January 1999 and December 2001, 317 patients 
      with GERD were treated by laparoscopic hemifundoplication and grouped in patients 
      with adequate response to PPI (n = 103) and patients with residual discomfort in 
      spite of or by PPI (n = 214). Preoperative diagnostic included endoscopy, 
      ph-testing, manometry and quality of life scoring by a standardized 
      questionnaire. Peri- and postoperative morbidity as well as quality of life were 
      analyzed and compared with healthy individuals (n = 50). RESULTS: Patient 
      demographics and surgical procedures did not differ between the two groups. After 
      a median follow-up of 49 months and a follow-up rate of 89.9 %, the recurrence 
      rate was 2.5 % and perioperative complication rate was 6.3 % without any 
      significant differences between the groups. Patients with GERD and adequate 
      response to PPI showed preoperatively during PPI omission a significant lower 
      incidence of esophagitis (3.9 % vs. 18.2 %) and higher quality of life score 
      (93.7 +/- 11.3 vs. 75.3 +/- 12.6), which significantly decreased in comparison to 
      healthy individuals (132.9 +/- 10.5). After anti-reflux surgery the quality of 
      life has been increased in both groups (130.5 +/- 11.4 vs. 121.8 +/- 13.2). 
      However, only patients with adequate response to PPI reached the quality of life 
      score of healthy individuals. CONCLUSION: Patients with preoperatively adequate 
      response to PPI profit of anti-reflux surgery in terms of postoperative quality 
      of life. Concerning the indication for anti-reflux surgery in these patients, one 
      has to balance between the individual inconvenience due to the long-lasting drug 
      intake on the one hand and the operative risk, morbidity and outcome of a 
      specialized surgical department on the other hand.
FAU - Horstmann, R
AU  - Horstmann R
AD  - Klinik fur Allgemein-, Viszeral- und Gefasschirurgie, Herz-Jesu-Krankenhaus 
      Munster. horstmann@herz-jesu-kh-ms.de
FAU - Gregor, N
AU  - Gregor N
FAU - Classen, C
AU  - Classen C
FAU - Rottgermann, S
AU  - Rottgermann S
FAU - Palmes, D
AU  - Palmes D
LA  - ger
PT  - English Abstract
PT  - Journal Article
TT  - Antirefluxchirurgie bei patienten mit adaquatem ansprechen auf 
      protonenpumpeninhibitoren - sinnvoll oder ubertherapiert?
PL  - Germany
TA  - Z Gastroenterol
JT  - Zeitschrift fur Gastroenterologie
JID - 0033370
RN  - 0 (Anti-Ulcer Agents)
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Anti-Ulcer Agents/*administration & dosage/adverse effects
MH  - Drug Resistance
MH  - Female
MH  - Follow-Up Studies
MH  - Fundoplication/*methods
MH  - Gastric Acidity Determination
MH  - Gastroesophageal Reflux/*surgery
MH  - Humans
MH  - Laparoscopy/*methods
MH  - Long-Term Care
MH  - Male
MH  - Middle Aged
MH  - Prospective Studies
MH  - *Proton Pump Inhibitors
MH  - Quality of Life/psychology
MH  - Recurrence
MH  - Treatment Outcome
EDAT- 2006/12/14 09:00
MHDA- 2007/03/01 09:00
CRDT- 2006/12/14 09:00
PHST- 2006/12/14 09:00 [pubmed]
PHST- 2007/03/01 09:00 [medline]
PHST- 2006/12/14 09:00 [entrez]
AID - 10.1055/s-2006-927123 [doi]
PST - ppublish
SO  - Z Gastroenterol. 2006 Dec;44(12):1217-22. doi: 10.1055/s-2006-927123.