PMID- 24985244
OWN - NLM
STAT- MEDLINE
DCOM- 20150512
LR  - 20240213
IS  - 1873-4626 (Electronic)
IS  - 1091-255X (Linking)
VI  - 18
IP  - 9
DP  - 2014 Sep
TI  - Outcome of laparoscopic Nissen fundoplication for gastroesophageal reflux disease 
      in non-responders to proton pump inhibitors.
PG  - 1557-62
LID - 10.1007/s11605-014-2584-3 [doi]
AB  - BACKGROUND: Gastroesophageal reflux disease (GERD) is a common public health 
      problem. Medical treatment remains the first line of treatment of GERD. Failure 
      of medical treatment may occur in up to 45% of GERD patients. This study aims to 
      evaluate the outcome of laparoscopic Nissen fundoplication (LNF) as a means of 
      antireflux surgery in patients with poor response to anti-reflux medication. 
      PATIENTS AND METHODS: This is a prospective study of patients who underwent LNF 
      in the period between January 2000 and December 2010 in the Gastrointestinal 
      Surgical Center, Mansoura University, Egypt. Patients were assessed 
      preoperatively and postoperatively, after 1 year, by clinical examination, 
      esophagogastroscope, barium esophagography, esophageal manometry and 24-h pH 
      monitoring. Patient satisfaction after surgery was also graded through a 
      questionnaire. RESULTS: The study population was 370 patients. 296 patients were 
      good responders to proton pump inhibitors (PPI) while 74 patients were PPI 
      non-responders. Preoperatively, atypical reflux symptoms were significantly more 
      in PPI non-responders (P = 0.006). On follow-up, PPI responders significantly 
      reported relief of heartburn (P = 0.01) and regurgitation (P = 0.04). Patient 
      satisfaction was more in PPI responders (P = 0.04). Both groups were comparable 
      regarding anatomical and functional assessment. Integrity of the wrap was higher 
      in PPI responders (P = 0.04). CONCLUSION: PPI non-responders should not be 
      precluded from LNF. Thorough assessment is mandatory to confirm GERD diagnosis. A 
      substantial proportion of PPI failures show good response to LNF but 
      significantly than clinical response in PPI responders. Increased likelihood of 
      poor outcome after surgery should be discussed with the patient.
FAU - Hamdy, Emad
AU  - Hamdy E
AD  - Mansoura University Hospital, Mansoura, Egypt.
FAU - El Nakeeb, Ayman
AU  - El Nakeeb A
FAU - Hamed, Hosam
AU  - Hamed H
FAU - El Hemaly, Mohamed
AU  - El Hemaly M
FAU - ElHak, Nabil Gad
AU  - ElHak NG
LA  - eng
PT  - Journal Article
DEP - 20140702
PL  - Netherlands
TA  - J Gastrointest Surg
JT  - Journal of gastrointestinal surgery : official journal of the Society for Surgery 
      of the Alimentary Tract
JID - 9706084
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
MH  - Adult
MH  - Deglutition Disorders/drug therapy/etiology
MH  - Drug Resistance
MH  - Female
MH  - *Fundoplication
MH  - Gastroesophageal Reflux/complications/*drug therapy/*surgery
MH  - Heartburn/drug therapy/etiology
MH  - Humans
MH  - Laparoscopy
MH  - Laryngopharyngeal Reflux/drug therapy/etiology
MH  - Male
MH  - Middle Aged
MH  - Patient Satisfaction
MH  - Prospective Studies
MH  - Proton Pump Inhibitors/*therapeutic use
MH  - Treatment Outcome
EDAT- 2014/07/06 06:00
MHDA- 2015/05/13 06:00
CRDT- 2014/07/03 06:00
PHST- 2014/04/27 00:00 [received]
PHST- 2014/06/20 00:00 [accepted]
PHST- 2014/07/03 06:00 [entrez]
PHST- 2014/07/06 06:00 [pubmed]
PHST- 2015/05/13 06:00 [medline]
AID - S1091-255X(23)04712-1 [pii]
AID - 10.1007/s11605-014-2584-3 [doi]
PST - ppublish
SO  - J Gastrointest Surg. 2014 Sep;18(9):1557-62. doi: 10.1007/s11605-014-2584-3. Epub 
      2014 Jul 2.