Recurrent symptoms after fundoplication with a negative pH study--recurrent reflux or functional heartburn?

Abstract

INTRODUCTION:

A small cohort of patients present after antireflux surgery complaining of recurrent heartburn. Over two thirds of these patients will have a negative 24-h pH study. The aim of our study is to determine whether these patients have an associated functional disorder or abnormal cytokine activity and to examine the reproducibility of pH testing.

METHODS:

A prospective analysis was carried out on a cohort of patients who had undergone a fundoplication and postoperative pH testing for recurrent heartburn: group A--patients with recurrent heartburn and a negative 24-h pH study and group B (control group)--patients with recurrent heartburn and a positive pH study. Questionnaires, a blood sample, and repeat pH testing were completed.

RESULTS:

Sixty-nine patients were identified. Group A's depression score (8.6 +/- 4.1) was significantly higher than group B's (5.9 +/- 4.2; P = 0.03). Cytokine levels were similar in both groups. Forty-seven of 49 (96%) patients who underwent repeat pH testing had a negative study. Symptom-reflux correlation was highly significant (P < 0.001).

CONCLUSION:

Some patients with recurrent heartburn and a negative pH study have associated functional or psychiatric comorbidities such as depression. Reproducibility of 24-h pH testing in these patients is excellent.

• Authors: Sarah K Thompson, Wang Cai, Glyn G Jamieson, Alison Y Zhang, Jennifer C Myers, Zoe E Parr, David I Watson, Jenny Persson, Gerald Holtmann, Peter G Devitt
• Journal: Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract (J Gastrointest Surg) Vol. 13 Issue 1 Pg. 54-60 (Jan 2009) ISSN: 1873-4626 [Electronic] United States
• PMID: 18712573 (Publication Type: Comparative Study, Journal Article)

Topics

• Esophageal pH Monitoring
• Female
• Follow-Up Studies
• Fundoplication (methods)
• Gastroesophageal Reflux (metabolism, surgery)
• Heartburn (metabolism, surgery)
• Humans
• Hydrogen-Ion Concentration
• Laparoscopy
• Male
• Middle Aged
• Postoperative Period
• Prognosis
• Prospective Studies
• Recurrence
• Risk Factors