Evaluation of the Outcomes of Anti-Reflux Surgery in the Management of Extraoesophageal Symptoms of Gastro-oesophageal Reflux Disease

Background About one third of gastro-oesophageal reflux disease (GORD) patients were found to have atypical or extra-oesophageal symptoms (EOS), which represent a diagnostic and therapeutic challenge. The efficacy of the current treatment strategy used to control these symptoms is still controversial. Anti-reflux surgery has been shown to significantly improve respiratory symptoms associated with GORD.
Objective: The aim of the current study was to evaluate the outcomes of laparoscopic fundoplication to control GORD-related EOS.
Patient and methods: A prospective cohort study was conducted and included patients diagnosed with GORD with or without EOS or predominant EOS who were referred from Respiratory or ENT Departments. All participants underwent laparoscopic fundoplication surgery. Data about patients’ demographics, body mass index (BMI), GORD/EOS presenting symptoms, 24 pH/manometry results, oesphagogastroduodenscopy findings, perioperative outcomes, quality of life using gastrointestinal quality of life Index (GIQOLI)questionnaire, patient’s satisfaction using modified Visick score, and EOS severity using reflux symptom index (RSI) preoperatively, and 6 months postoperatively were collected and statistically analyzed. Results: A total number of 103 were included withmean age of 45.6 (SD 8.7) years, and 60% of the study’s population was female. Mean BMI was 27.25 (SD 3.6). Heart burn was the main symptoms in all patients (71.9%), while chronic cough was the main EOS (27%). The mean operative time was 96 (SD 19.21) minutes, and mean hospital stay was 1.21 (SD 0.42) day. There was significant improvement in quality of life [65.7 (SD 11.6) and 118 (SD 12.8)] and reflux score [93.76 (SD 0.8) and 1.7 (SD 0.6)], RSI score for EOS [19.89 (SD 14.7) and 4.3 (SD5.3)] preoperatively and 6 month postoperatively respectively.
Conclusion Laparoscopic fundoplication is a feasible option to control EOS associated with GORD with significant improvement of quality of life and reflux symptom index. Further larger studies are still warranted to evaluate the benefits on the long term.