Duodenogastric Reflux
Conditions
Keywords
Duodenogastroesophageal reflux, Weakly acidic reflux, Gastric emptying, Laparoscopic fundoplication
Brief summary
After laparoscopic total fundoplication (LTF) 12-15% of patients have persistent reflux symptoms and 20-25% develop gas-related symptoms. Reflux symptoms, gas bloating and inability to belch occurring after surgery have been associated with mixed (acid and weakly acid) (MR) or weakly acidic reflux (WAR). To date, few studies have evaluated functional outcome after LTF in patients with MR or WAR, with the majority reporting only short-term results. It has been shown that delayed gastric emptying (DGE) might also be an important factor for abdominal distension and adverse outcome after LTF.9,10 However, the correlation between poor long-term outcome after LTF and DGE is controversial. In addition, the effect of DGE in patients with MR or WAR is poorly investigated.
Detailed description
In the last years the study of gastro-oesophageal reflux has been revolutionized by the development of combined 24-h esophageal pH and multichannel intraluminal impedance (MII) monitoring. Combined esophageal MII and pH-monitoring allow for the timed correlation of esophageal pH changes with reflux events and achieve high sensitivity for the detection of acid (pH \<4), weakly acidic (pH 4-7) and weakly alkaline (pH \>7) reflux episodes. Use of this technology is bringing into focus the potential role of weakly acidic and weakly alkaline reflux in symptoms that persist despite acid suppressive therapy or anti-reflux surgery.
Interventions
PROCEDURElaparoscopic total fundoplication
LTF was performed using a standard five-trocar technique in all cases and carried out by two expert surgeons who had previously performed more than 50 laparoscopic fundoplications. A floppy 360° total fundoplication of 2-2,5 cm was constructed after full esophageal mobilization and posterior crural repair with nonabsorbable sutures.
Sponsors
University of Turin, Italy
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
14 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
\- The study population consisted of consecutive patients with weakly acidic gastroesophageal reflux (GER) confirmed by 24 hour pH and impedance monitoring and eligible for laparoscopic antireflux surgery (LARS).
Exclusion criteria
\-
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| number of acidic and weakly acidic reflux | 60 months after LTF | number of acidic and weakly acidic reflux at 24 hour pH impedance monitoring |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| GERD Health related quality of Life score | 60 months after LTF | Standard and previous validate questionnaire was employed in the study to assess gastroesophageal function and quality of life |
| Gastro-esophageal junction pressure | 60 months after surgery | Gastroesophageal junction pressure was evaluated with esophageal manometry |
| Gastric emptying | 1 months before surgery | Gastric emptying was evaluated with gastric scintigraphy before LTF |
Countries
Italy
Outcome results
None listed