Laparoscopic Nissen–Rossetti Fundoplication Is a Safe and Effective Treatment for Both Acid and Bile Gastroesophageal Reflux in Patients Poorly Responsive to Proton Pump Inhibitor
Restricted accessResearch articleFirst published online December, 2011
Laparoscopic Nissen–Rossetti Fundoplication Is a Safe and Effective Treatment for Both Acid and Bile Gastroesophageal Reflux in Patients Poorly Responsive to Proton Pump Inhibitor
Purpose. The aim of this study was to evaluate the effectiveness of laparoscopic Nissen–Rossetti fundoplication in patients with gastroesophageal reflux disease (GERD) poorly responsive to standard dose proton pump inhibitor (PPI) therapy. Methods. A total of 35 patients (19 women, 16 men, mean age 44.6 ± 14.01 years) were enrolled. All the patients underwent symptom questionnaires, upper gastrointestinal endoscopy, esophageal manometry, and combined 24-hour esophageal pH and bilirubin monitoring. Following this, the patients with persistent pathological esophageal acid and/or bilirubin exposure underwent laparoscopic antireflux surgery, followed by clinical and instrumental 12-month follow-up. Results. One year after surgery, there was a significant improvement of symptom score, compared with standard PPI dose period (3.54 ± 1.67 vs 20.8 ± 10.9, P < .0001; paired t test) and mean percentage total time acid and bile exposure showed a significant decrease (4.9 ± 2.9 vs 2.03 ± 0.74 and 8.3 ± 3.03 vs 0.84 ± 0.56, P < .0001; paired t test). Conclusions. In patients with GERD poorly responsive to standard PPI dose, laparoscopic Nissen–Rossetti fundoplication appears to be a safe and effective treatment of symptoms, esophageal damage, as well as both acid and bile reflux.
DentJEL-SeragHBWallanderMA. Epidemiology of gastro-esophageal reflux disease: a systematic review. Gut. 2005;54:710-717.
2.
PaceFBollaniSMolteniPBianchi PorroG. Natural history of gastro-oesophageal reflux disease without oesophagitis (NERD): a reappraisal 10 years on. Dig Liver Dis. 2004;36:111-115.
SpechlerSJ. Epidemiology and natural history of gastro-esophageal reflux disease. Digestion. 1992;51:24-29.
5.
EarnestDLDorschEJonesJJenningsDEGreski-RosePA. A placebo-controlled dose-ranging study of lansoprazole in the management of reflux esophagitis. Am J Gastroenterol. 1998;93:238-243.
6.
MehtaSHindmarshARhodesM. Changes in functional gastrointestinal symptoms as a results of antireflux surgery. Surg Endosc. 2005;19:1447-1450.
7.
van der PeetDLKlinkenberg-KnolECEijsboutsQAvan den BergMde BrauwLMCuestaMA. Laparoscopic Nissen fundoplication for treatment of gastroesophageal reflux disease (GERD). Surgery after extensive conservative treatment. Surg Endosc. 1998;12:1159-1163.
8.
ChibaNDe GaraCJ. Speed of healing and symptoms relief in grade II to IV gastroesophageal reflux disease: a meta-analysis. Gastroenterology. 1997;112:1798-1810.
9.
HollowayRHDentJNarielvalaFMackinnonAM. Relation between oesophageal acid exposure and healing of oesophagitis with omeprazole. Gut. 1996;38:649-654.
10.
KatzkaDAPaolettiVLeiteLCastellDO. Prolonged ambulatory pH monitoring in patients with persistent gastroesophageal reflux disease symptoms: testing while on therapy identifies the need for more aggressive antireflux therapy. Am J Gastroenterol. 1996;91:2110-2113.
11.
TackJKoekGDemedtsISifrimDJanssensJ. Gastroesophageal reflux disease poorly responsive to single dose proton pump inhibitors in patients without Barrett’s esophagus: acid reflux, bile reflux, or both?Am J Gastroenterol. 2004;99:981-988.
12.
Klikenberg-KnolECFestenHPJansenJB. Long-term treatment with omeprazole for refractory reflux esophagitis: efficacy and safety. Ann Intern Med. 1994;121:161-167.
13.
SteinHJKauerWKFeussnerHSiewertJR. Bile reflux in benign and malignant Barrett’s esophagus: effect of medical acid suppression and Nissen fundoplication. J Gastrointest Surg. 1998;2:333-341.
14.
MahonDRhodesMDecadtB. Randomized clinical trial of laparoscopic Nissen fundoplication compared with proton-pump inhibitors for treatment of chronic gastro-oesophageal reflux. Br J Surg. 2005;92:695-699.
15.
MehtaSBennettJMahonDRhodesM. Prospective trial of laparoscopic Nissen fundoplication versus proton pump inhibitor therapy for gastroesophageal reflux disease: seven-year follow-up. J Gastrointest Surg. 2006;10:1312-1316.
16.
PatelAADoneganDAlbertT. The 36-item short form. J Am Acad Orthop Surg. 2007;15:126-134.
17.
StreetsCGDeMeesterSRDeMeesterTR. Excellent quality of life after Nissen fundoplication depends on successful elimination of reflux symptoms and not the invasiveness of the surgical approach. Ann Thorac Surg. 2002;74: 1019-1024.
18.
BalciDTurkcaparAG. Assessment of quality of life after laparoscopic Nissen fundoplication in patients with gastroesophageal reflux disease. World J Surg. 2007;31:116-121.
19.
LundellLRDentJBennettJR. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut. 1999;45:172-180.
20.
PassarettiSZaninottoGDi MartinoNLeoPCostantiniMBaldiF. Standards for oesophageal manometry. A position statement from the Gruppo Italiano di Studio Motilità Apparato Digerente (GISMAD). Dig Liver Dis. 2000;32:46-55.
21.
FeinMFuchsKHBohrerTFreysSMThiedeA. Fiberoptic technique for 24-hour bile reflux monitoring. Standards and normal values for gastric monitoring. Dig Dis Sci. 1996;41:216-225.
22.
RomagnoliRCollardJMBechiPSalizzoniM. Gastric symptoms and duodenogastric reflux in patients referred for gastroesophageal reflux symptoms and endoscopic esophagitis. Surgery. 1999;125:480-486.
23.
BarrettMWMyersJCWatsonDIJamiesonGG. Dietary interference with the use of Bilitec to assess bile reflux. Dis Esophagus. 1999;2:60-64.
24.
JohnsonLFDeMeesterTR. Twenty-four-hour pH monitoring of the distal esophagus. A quantitative measure of gastroesophageal reflux. Am J Gastroenterol. 1974;62:325-332.
25.
MarshallREAnggiansahAOwenWAOwenWJ. The relationship between acid and bile reflux and symptoms in gastroesophageal reflux disease. Gut. 1997;40:182-187.
26.
MarshallREAnggiansahAOwenWAOwenWJ. Investigation of gastro-oesophageal reflux in patients with an intact stomach: is oesophageal bilirubin monitoring a useful addition to pH monitoring?Scand J Gastroenterol. 2000;9:904-909.
27.
SontagSJHirwhowitzBIHoltS. Two doses of omeprazole versus placebo in symptomatic erosive esophagitis: the U.S. multicenter study. Gastroenterology. 1992;102:108-118.
28.
Klinkenberg-KnolECNelisFDentJ. Long-term omeprazole treatment in resistant gastroesophageal reflux disease: efficacy, safety and influence on gastric mucosa. Gastroenterology. 2000;118:661-669.
29.
RichterJEKahrilasPJJohansonJ. Efficacy and safety of esomeprazole with omeprazole in GERD patients with erosive esophagitis: a randomized controlled trial. Am J Gastroenterol. 2001;96:656-665.
30.
AnvariMAllenC. Surgical outcome in gastro-esophageal reflux disease patients with inadequate response to proton pump inhibitors. Surg Endosc. 2003;17:1029-1035.
31.
MarshallREAnggiansahAManifoldDKOwenWAOwenWJ. Effect of omeprazole 20 mg twice daily on duodenogastric and gastroesophageal bile reflux in Barrett’s esophagus. Gut. 1998;2:333-337.
32.
MengesMMullerMZeitzM. Increased acid and bile reflux in Barrett’s esophagus compared to reflux esophagitis, and effect of PPI therapy. Am J Gastroenterol. 2001;96:331-337.
33.
ChampionGRichterJEVaeziMFSinghSAlexanderR. Duodenogastroesophageal reflux: relationship to pH and importance in Barrett’s esophagus. Gastroenterology. 1994;107:747-754.
34.
KauerWKPetersJHDeMeesterTRIrelandAPBremnerCGHagenJA. Mixed reflux of gastric and duodenal juices is more harmful to the esophagus than gastric juice alone. The need for surgical therapy reemphasized. Ann Surg. 1995;222:525-531.
35.
VaeziMFRichterJE. Role of acid and duodenogastroesophageal reflux in gastroesophageal reflux disease. Gastroenterology. 1996;111:1192-1199.
36.
ShiGBruley des VarannesSScarpignatoCLe RhunMGalmicheJP. Reflux-related symptoms in patients with normal oesophageal exposure to acid. The acid hypersensitive esophagus. Gut. 1995;37:457-464.
37.
TutuianRVelaMFShaySSCastellDO. Multichannel intraluminal impedance in esophageal function testing and gastroesophageal reflux monitoring. J Clin Gastroenterol. 2003;37:206-215.
38.
MainieITutuianRShayS. Acid and non-acid reflux in patients with persistent symptoms despite acid suppressive therapy. A multicentre study using combined ambulatory impedance-pH monitoring. Gut. 2006;55:1398-1402.
39.
MainieITutuianRAgrawalAAdamsDCastellDO. Combined multichannel intraluminal impedance-pH monitoring to select patients with persistent gastro-oesophageal reflux for laparoscopic Nissen fundoplication. Br J Surg. 2006;93:1483-1487.
40.
van der PeetDLKlinkenberg-KnolECEijsboutsQAvan den BergMde BrauwLMCuestaMA. Laparoscopic Nissen fundoplication for the treatment of gastroesophageal reflux disease (GERD). Surgery after extensive conservative treatment. Surg Endosc. 1998;12:1159-1163.
41.
AnvariMAllenCBormA. Laparoscopic Nissen fundoplication is a satisfactory alternative to long-term omeprazole therapy. Br J Surg. 1995;82:938-942.
