Long-term outcome of Nissen fundoplication in non-erosive and erosive gastro-oesophageal reflux disease

✍ Scribed by J. A. Broeders; W. A. Draaisma; A. J. Bredenoord; A. J. Smout; I. A. Broeders; Professor H. G. Gooszen

• Publisher: John Wiley and Sons
• Year: 2010
• Tongue: English
• Weight: 140 KB
• Volume: 97
• Category: Article
• ISSN: 0007-1323
• DOI: 10.1002/bjs.7023

✦ Synopsis

Abstract

Background

Non-erosive (NERD) and erosive (ERD) gastro-oesophageal reflux disease (GORD) show similar severity of symptoms and impact on quality of life (QoL). Prospective data on long-term outcomes of antireflux surgery in NERD are lacking.

Methods

Subjective and objective 5-year outcomes of Nissen fundoplication were compared in 96 patients with NERD and 117 with ERD, operated on for proton-pump inhibitor (PPI)-refractory GORD.

Results

Preoperative and postoperative QoL, PPI use, acid exposure time, symptom–reflux correlation, lower oesophageal sphincter (LOS) pressure and reoperation rates were similar in the two groups. At 5 years, relief of reflux symptoms was similar (NERD 89 per cent versus ERD 96 per cent), PPI use showed a similar reduction (82 to 21 per cent versus 81 to 15 per cent respectively; both P < 0·001) and QoL score improved equally (50·3 to 65·2 (P < 0·001) versus 52·0 to 60·7 (P = 0·016)). Five patients with NERD developed erosions after surgery; oesophagitis healed in 87 per cent of patients with ERD. Reduction in total acid exposure time (NERD 12·7 to 2·0 per cent versus ERD 13·8 to 2·9 per cent; both P < 0·001) and increase in LOS pressure (1·3 to 1·8 kPa versus 1·2 to 1·8 kPa; both P < 0·001) were similar. The reintervention rate was comparable (NERD 15 per cent versus ERD 12·8 per cent).

Conclusion

Patients with PPI-refractory NERD and ERD benefit equally from Nissen fundoplication. The absence of mucosal lesions on endoscopy in patients with proven PPI-refractory reflux disease is not a reason to refrain from antireflux surgery.