caa a22 4500 445796219 CHVBK 20180317145126.0 cr unu---uuuuu 170323e20110401xx s 000 0 eng 10.1007/s10620-010-1381-4 doi (NATIONALLICENCE)springer-10.1007/s10620-010-1381-4 Reflux Parameters as Modified by Laparoscopic Fundoplication in 40 Patients with Heartburn/Regurgitation Persisting Despite PPI Therapy: A Study Using Impedance-pH Monitoring [Elektronische Daten] [Marzio Frazzoni, Rita Conigliaro, Gianluigi Melotti] Background: Patients with typical reflux symptoms (heartburn/regurgitation) persisting despite proton pump inhibitor (PPI) therapy are not uncommon. Impedance-pH monitoring detects gastroesophageal reflux at all pH levels and may establish if ongoing symptoms on PPI therapy are associated with acid/nonacid reflux. Laparoscopic fundoplication is a therapeutic option in such patients but reflux parameters on PPI therapy and after intervention and their relationship with symptom persistence/remission have been scarcely studied. Aims: The aim of this study was to assess reflux parameters and their relationship with symptoms before and after laparoscopic fundoplication, on and off PPI therapy, respectively, in patients with PPI-unresponsive heartburn/regurgitation and with a positive symptom-reflux association and/or abnormal reflux parameters detected on PPI therapy. Methods: Impedance-pH monitoring was performed on high-dose PPI therapy and 3months after laparoscopic fundoplication, off PPI therapy, in 40 patients with PPI-unresponsive heartburn/regurgitation. Symptoms were scored by a validated questionnaire. Results: Esophageal acid exposure time as well as the number of total and proximal reflux events and of acid and weakly acidic refluxes decreased significantly after surgery: normal values were found in 100, 77, 95, 92 and 65% of cases, respectively. Weakly alkaline refluxes increased significantly postoperatively but neither before nor after intervention were associated with symptoms. All patients reported total/subtotal remission of heartburn/regurgitation 3months after surgery. Conclusions: Laparoscopic fundoplication improves acid and weakly acidic reflux parameters when compared with PPI therapy. This improvement justifies the very high post-surgical symptom remission rate that we observed. Prolonged follow-up is warranted but our findings strongly support the surgical option in PPI failures. Springer Science+Business Media, LLC, 2010 Gastroesophageal reflux disease nationallicence Proton pump inhibitors nationallicence Reflux monitoring nationallicence Laparoscopic Nissen fundoplication nationallicence Acid reflux nationallicence Non acid reflux nationallicence GERD : Gastroesophageal reflux disease nationallicence PPI : Proton pump inhibitor nationallicence LES : Lower esophageal sphincter nationallicence DEA : Distal esophageal amplitude nationallicence GAET : Gastric acid exposure time nationallicence EAET : Esophageal acid exposure time nationallicence SAP : Symptom association probability nationallicence SI : Symptom index nationallicence Frazzoni Marzio Fisiopatologia Digestiva, Nuovo Ospedale S. Agostino, Viale Giardini 1355, 41100, Modena, Italy aut Conigliaro Rita Gastroenterologia, Nuovo Ospedale S. Agostino, Viale Giardini 1355, 41100, Modena, Italy aut Melotti Gianluigi Chirurgia Generale, Nuovo Ospedale S. Agostino, Viale Giardini 1355, 41100, Modena, Italy aut Digestive Diseases and Sciences Springer US; http://www.springer-ny.com 56/4(2011-04-01), 1099-1106 0163-2116 56:4<1099 2011 56 10620 https://doi.org/10.1007/s10620-010-1381-4 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s10620-010-1381-4 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Frazzoni Marzio Fisiopatologia Digestiva, Nuovo Ospedale S. Agostino, Viale Giardini 1355, 41100, Modena, Italy aut NATIONALLICENCE 700 1- Conigliaro Rita Gastroenterologia, Nuovo Ospedale S. Agostino, Viale Giardini 1355, 41100, Modena, Italy aut NATIONALLICENCE 700 1- Melotti Gianluigi Chirurgia Generale, Nuovo Ospedale S. Agostino, Viale Giardini 1355, 41100, Modena, Italy aut NATIONALLICENCE 773 0- Digestive Diseases and Sciences Springer US; http://www.springer-ny.com 56/4(2011-04-01), 1099-1106 0163-2116 56:4<1099 2011 56 10620 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer