Ciro Andolfi1, Luigi Bonavina2, Robert T Kavitt3, Vani J A Konda3, Emanuele Asti2, Marco G Patti1. 1. 1 Department of Surgery, Pritzker School of Medicine, University of Chicago , Chicago, Illinois. 2. 2 Department of Surgery, School of Medicine, University of Milan , Milan, Italy . 3. 3 Department of Gastroenterology, Pritzker School of Medicine, University of Chicago , Chicago, Illinois.
Abstract
BACKGROUND: Patients who have heartburn are treated with acid-reducing medications on the assumption that gastroesophageal reflux disease (GERD) is causing the symptom. In the absence of a response to therapy, patients are often assumed to have refractory GERD, and they are referred for laparoscopic antireflux surgery (LARS), often without further diagnostic evaluation. HYPOTHESIS: We hypothesized that (1) in some patients with refractory GERD, the heartburn is not secondary to reflux, but rather to stasis and fermentation of food in the presence of achalasia and (2) esophageal manometry and pH monitoring are essential to establish proper diagnosis. PATIENTS AND METHODS: Five hundred twenty-four patients, whose final diagnosis was achalasia, were referred to two quaternary care centers. Symptomatic evaluation, barium swallow, endoscopy, manometry, and pH monitoring were performed in all patients. RESULTS: One hundred fifty-two patients (29%) had been treated with acid-reducing medications for an average of 29.3 months, and were referred for LARS because of lack of response to medical therapy. One patient had already been treated with a Nissen fundoplication. All patients were diagnosed with achalasia and underwent Heller myotomy and partial fundoplication. CONCLUSIONS: The results of this study showed that (1) one-third of achalasia patients complained of heartburn and (2) patients with heartburn not responding to medical treatment must be carefully evaluated before referral to surgery. These data confirm the importance of esophageal manometry and pH monitoring in any patient considered for LARS.
BACKGROUND:Patients who have heartburn are treated with acid-reducing medications on the assumption that gastroesophageal reflux disease (GERD) is causing the symptom. In the absence of a response to therapy, patients are often assumed to have refractory GERD, and they are referred for laparoscopic antireflux surgery (LARS), often without further diagnostic evaluation. HYPOTHESIS: We hypothesized that (1) in some patients with refractory GERD, the heartburn is not secondary to reflux, but rather to stasis and fermentation of food in the presence of achalasia and (2) esophageal manometry and pH monitoring are essential to establish proper diagnosis. PATIENTS AND METHODS: Five hundred twenty-four patients, whose final diagnosis was achalasia, were referred to two quaternary care centers. Symptomatic evaluation, barium swallow, endoscopy, manometry, and pH monitoring were performed in all patients. RESULTS: One hundred fifty-two patients (29%) had been treated with acid-reducing medications for an average of 29.3 months, and were referred for LARS because of lack of response to medical therapy. One patient had already been treated with a Nissen fundoplication. All patients were diagnosed with achalasia and underwent Heller myotomy and partial fundoplication. CONCLUSIONS: The results of this study showed that (1) one-third of achalasiapatients complained of heartburn and (2) patients with heartburn not responding to medical treatment must be carefully evaluated before referral to surgery. These data confirm the importance of esophageal manometry and pH monitoring in any patient considered for LARS.
Authors: Rafael Melillo Laurino Neto; Fernando A M Herbella; Andre Zugman; Vic Velanovich; Beth Montera; Francisco Schlottmann; Marco G Patti Journal: Surg Endosc Date: 2019-02-27 Impact factor: 4.584
Authors: C Prakash Gyawali; Dustin A Carlson; Joan W Chen; Amit Patel; Robert J Wong; Rena H Yadlapati Journal: Am J Gastroenterol Date: 2020-09 Impact factor: 12.045