Isolated upright gastroesophageal reflux is not a contraindication for antireflux surgery

被引:16
作者
Fein, M [1 ]
Hagen, JA [1 ]
Ritter, MP [1 ]
DeMeester, TR [1 ]
DeVos, M [1 ]
Bremner, CG [1 ]
机构
[1] UNIV SO CALIF,SCH MED,DEPT SURG,LOS ANGELES,CA 90033
关键词
D O I
10.1016/S0039-6060(97)90094-5
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background. Patients with gastroesophageal reflux disease who reflux only in the upright position are thought to have a less severe abnormality. Controversy exists over whether these patients should be considered candidates for antireflux surgery. Methods. A total of 224 consecutive patients with increased esophageal acid exposure on 24-hour pH monitoring were classified as having upright (n = 54), supine (n = 72), or bipositional (n = 98) reflux and were evaluated by manometry and endoscopy. Of these, 116 patients had a laparoscopic Nissen fundoplication. Their clinical outcome at a median of 12 months (range 4 to 44 months) was compared. Results. Patients with upright reflux had a lower prevalence of a structurally defective lower esophageal sphincter, fewer hiatal hernias, and less esophageal injury when compared to those with bipositional reflux (p < 0.05). Excellent (asymptomatic) or good outcome (minor symptoms not requiring acid suppression therapy) was achieved in 86% of the patients with upright reflux, 90% of those with supine reflux, and 89% of those with bipositional reflux. Conclusions. Patients with upright reflux have less complicated, earlier disease and have results equivalent to those patients with supine and bipositional reflux after antireflux surgery.
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页码:829 / 835
页数:7
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