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Esophageal symptoms following antireflux surgery: Issues and management

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Current GERD Reports

Abstract

Laparoscopic antireflux surgery is a widely used and effective option in the properly selected patient with gastroesophageal reflux disease. Poor symptomatic outcomes occur even in the best of hands, the most common being recurrent or persistent heartburn (or atypical symptoms) and dysphagia. When heartburn predominates, anatomic and physiologic evaluation is needed to determine whether acid reflux is controlled and if the postoperative neoanatomy is appropriate. Dysphagia in the immediate postoperative setting mandates reassurance, as conservative measures alone often suffice. With persistent dysphagia, anatomic and physiologic evaluation again is indicated in search of a mechanical, motility, or reflux-related symptom basis. Reoperation carries substantial morbidity and reduced success rates when compared with the initial procedure, mandating careful patient selection and referral to a center with thorough surgical experience in these procedures.

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References and Recommended Reading

  1. Frank L, Kleinman L, Ganoczy D, et al.: Upper gastro-intestinal symptoms in North America: prevalence and relationship to healthcare utilization and quality of life. Dig Dis Sci 2000, 45:809–818.

    Article  PubMed  CAS  Google Scholar 

  2. Little AG: Gastroesophageal reflux disease: a historical review of surgical therapy. J Surg Res 2004, 117:30–33.

    Article  PubMed  Google Scholar 

  3. Lundell L, Abrahamsson H, Ruth M, et al.: Long-term results of a prospective randomized comparison of total fundic wrap (Nissen-Rossetti) or semifundoplication (Toupet) for gastro-oesophageal reflux. Br J Surg 1996, 83:830–835.

    Article  PubMed  CAS  Google Scholar 

  4. Fernando HC, Luketich JD, Christie NA, et al.: Outcomes of laparoscopic Toupet compared to laparoscopic Nissen fundoplication. Surg Endosc 2002, 16:905–908.

    Article  PubMed  CAS  Google Scholar 

  5. Rydberg L, Ruth M, Lundell L: Mechanism of action of antireflux procedures. Br J Surg 1999, 86:405–410.

    Article  PubMed  CAS  Google Scholar 

  6. Ackroyd R, Watson DI, Majeed AW, et al.: Randomized clinical trial of laparoscopic versus open fundoplication for gastro-oesophageal reflux disease. Br J Surg 2004, 91:975–982.

    Article  PubMed  CAS  Google Scholar 

  7. Chrysos E, Tsiaoussis J, Athanasakis E, et al.: Laparoscopic vs open approach for Nissen fundoplication. A comparative study. Surg Endosc 2002, 16:1679–1684.

    Article  PubMed  CAS  Google Scholar 

  8. Bais JE, Bartelsman JF, Bonjer HJ, et al.: Laparoscopic or conventional Nissen fundoplication for gastro-oesophageal reflux disease: randomised clinical trial. The Netherlands Antireflux Surgery Study Group. Lancet 2000, 355:170–174.

    Article  PubMed  CAS  Google Scholar 

  9. Watson DI: Laparoscopic treatment of gastro-oesophageal reflux disease. Best Pract Res Clin Gastroenterol 2004, 18:19–35.

    Article  PubMed  Google Scholar 

  10. Waring JP, Hunter JG, Oddsdottir M, et al.: The preoperative evaluation of patients considered for laparoscopic antireflux surgery. Am J Gastroenterol 1995, 90:35–38.

    PubMed  CAS  Google Scholar 

  11. Lundell L, Miettinen P, Myrvold HE, et al.: Continued (5-year) follow up of a randomized clinical study comparing antireflux surgery and omeprazole in gastroesophageal reflux disease. J Am Coll Surg 2001, 192:172–179; discussion 179–181.

    Article  PubMed  CAS  Google Scholar 

  12. Spechler SJ: Comparison of medical and surgical therapy for complicated gastroesophageal reflux disease in veterans. The Department of Veterans Affairs Gastroesophageal Reflux Disease Study Group. N Engl J Med 1992, 326:786–792.

    Article  PubMed  CAS  Google Scholar 

  13. Spechler SJ, Lee E, Ahnen D, et al.: Long-term outcome of medical and surgical therapies for gastroesophageal reflux disease: follow-up of a randomized controlled trial. JAMA 2001, 285:2331–2338.

    Article  PubMed  CAS  Google Scholar 

  14. Luostarinen M, Isolauri J, Laitinen J, et al.: Fate of Nissen fundoplication after 20 years. A clinical, endoscopical, and functional analysis. Gut 1993, 34:1015–1020.

    Article  PubMed  CAS  Google Scholar 

  15. Watson DI, Jamieson GG: Antireflux surgery in the laparoscopic era. Br J Surg 1998, 85:1173–1184.

    Article  PubMed  CAS  Google Scholar 

  16. Hunter JG, Smith CD, Branum GD, et al.: Laparoscopic fundoplication failures: patterns of failure and response to fundoplication revision. Ann Surg 1999, 230:595–604, discussion 604–606.

    Article  PubMed  CAS  Google Scholar 

  17. Chen RY, Thomas RJ: Results of laparoscopic fundoplication where atypical symptoms coexist with oesophageal reflux. Aust N Z J Surg 2000, 70:840–842.

    Article  PubMed  CAS  Google Scholar 

  18. DeVault KR. Gastroesophageal reflux disease: extraesophageal manifestations and therapy. Semin Gastrointest Dis 2001, 12:46–51.

    PubMed  CAS  Google Scholar 

  19. Chahal PS, Rao SS: Functional chest pain: nociception and visceral hyperalgesia. J Clin Gastroenterol 2005, 39:S204–S209.

    Article  PubMed  Google Scholar 

  20. Sarkar S, Aziz Q, Woolf CJ, et al.: Contribution of central sensitisation to the development of non-cardiac chest pain. Lancet 2000, 356:1154–1159.

    Article  PubMed  CAS  Google Scholar 

  21. Robinson M: Review article: the pharmacodynamics and pharmacokinetics of proton pump inhibitors—overview and clinical implications. Aliment Pharmacol Ther 2004, 20(suppl 6):1–10.

    Article  PubMed  CAS  Google Scholar 

  22. Hellstrom PM, Vitols S: The choice of proton pump inhibitor: does it matter? Basic Clin Pharmacol Toxicol 2004, 94:106–111.

    Article  PubMed  Google Scholar 

  23. Ramirez B, Richter JE: Review article: promotility drugs in the treatment of gastro-oesophageal reflux disease. Aliment Pharmacol Ther 1993, 7:5–20.

    Article  PubMed  CAS  Google Scholar 

  24. Kahrilas PJ, Quigley EM, Castell DO, Spechler SJ: The effects of tegaserod (HTF 919) on oesophageal acid exposure in gastro-oesophageal reflux disease. Aliment Pharmacol Ther 2000, 14:1503–1509.

    Article  PubMed  CAS  Google Scholar 

  25. Tutuian R, Mainie I, Allan R, et al.: Effects of a 5-HT(4) receptor agonist on oesophageal function and gastro-oesophageal reflux: studies using combined impedance-manometry and combined impedance-pH. Aliment Pharmacol Ther 2006, 24:155–162.

    Article  PubMed  CAS  Google Scholar 

  26. Blum AL, Adami B, Bouzo MH, et al.: Effect of cisapride on relapse of esophagitis. A multinational, placebo-controlled trial in patients healed with an antisecretory drug. The Italian Eurocis Trialists. Dig Dis Sci 1993, 38:551–560.

    Article  PubMed  CAS  Google Scholar 

  27. Castell DO, Sigmund C Jr, Patterson D, et al.: Cisapride 20 mg b.i.d. provides symptomatic relief of heartburn and related symptoms of chronic mild to moderate gastroesophageal reflux disease. CIS-USA-52 Investigator Group. Am J Gastroenterol 1998, 93:547–552.

    Article  PubMed  CAS  Google Scholar 

  28. Prakash C, Clouse RE: Long-term outcome from tricyclic antidepressant treatment of functional chest pain. Dig Dis Sci 1999, 44:2373–2379.

    Article  PubMed  CAS  Google Scholar 

  29. Cannon RO 3rd, Quyyumi AA, Mincemoyer R, et al.: Imipramine in patients with chest pain despite normal coronary angiograms. N Engl J Med 1994, 330:1411–1417.

    Article  PubMed  Google Scholar 

  30. Clouse RE: Antidepressants for functional gastrointestinal syndromes. Dig Dis Sci 1994, 39:2352–2363.

    Article  PubMed  CAS  Google Scholar 

  31. Velanovich V: Tricyclic antidepressants in the treatment of postoperative antireflux surgery symptoms. Dig Liver Dis 2005, 37:458.

    Article  PubMed  CAS  Google Scholar 

  32. Vieweg WV, Wood MA: Tricyclic antidepressants, QT interval prolongation, and torsade de pointes. Psychosomatics 2004, 45:371–377.

    Article  PubMed  CAS  Google Scholar 

  33. Lim JK, Moisidis E, Munro WS, Falk GL: Re-operation for failed anti-reflux surgery. Aust N Z J Surg 1996, 66:731–733.

    Article  PubMed  CAS  Google Scholar 

  34. Horgan S, Pohl D, Bogetti D, et al.: Failed antireflux surgery: what have we learned from reoperations? Arch Surg 1999, 134:809–815; discussion 815–817.

    Article  PubMed  CAS  Google Scholar 

  35. Ellis FH Jr, Gibb SP, Heatley GJ: Reoperation after failed antireflex surgery. Review of 101 cases. Eur J Cardiothorac Surg 1996, 10:225–231; discussion 231–232.

    Article  PubMed  Google Scholar 

  36. Heniford BT, Matthews BD, Kercher KW, et al.: Surgical experience in fifty-five consecutive reoperative fundoplications. Am Surg 2002, 68:949–954; discussion 954.

    PubMed  Google Scholar 

  37. Smith CD, McClusky DA, Rajad MA, et al.: When fundoplication fails: redo? Ann Surg 2005, 241:861–869, discussion 869–871.

    Article  PubMed  Google Scholar 

  38. DePaula AL, Hashiba K, Bafutto M, Machado CA: Laparoscopic reoperations after failed and complicated antireflux operations. Surg Endosc 1995, 9:681–686.

    Article  PubMed  CAS  Google Scholar 

  39. Oelschlager BK, Lal DR, Jensen E, et al.: Medium-and long-term outcome of laparoscopic redo fundoplication. Surg Endosc 2006, Oct 9; [Epub ahead of print].

  40. Iqbal A, Jorde R, Lunde P, et al.: Left ventricular dysfunction in subjects with mild secondary hyperparathyroidism detected with pulsed wave tissue Doppler echocardiography. Cardiology 2006, 105:1–8.

    Article  PubMed  Google Scholar 

  41. Rantanen TK, Salo JA, Sipponen JT: Fatal and life-threatening complications in antireflux surgery: analysis of 5,502 operations. Br J Surg 1999, 86:1573–1577.

    Article  PubMed  CAS  Google Scholar 

  42. Bizekis C, Kent M, Luketich J: Complications after surgery for gastroesophageal reflux disease. Thorac Surg Clin 2006, 16:99–108.

    Article  PubMed  Google Scholar 

  43. Watson DI, Baigrie RJ, Jamieson GG: A learning curve for laparoscopic fundoplication. Definable, avoidable, or a waste of time? Ann Surg 1996, 224:198–203.

    Article  PubMed  CAS  Google Scholar 

  44. DeVault KR, Castell DO: Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. Am J Gastroenterol 2005, 100:190–200.

    Article  PubMed  Google Scholar 

  45. Barak N, Ehrenpreis ED, Harrison JR, Sitrin MD: Gastroesophageal reflux disease in obesity: pathophysiological and therapeutic considerations. Obes Rev 2002, 3:9–15.

    Article  PubMed  CAS  Google Scholar 

  46. Winslow ER, Frisella MM, Soper NJ, Klingensmith ME: Obesity does not adversely affect the outcome of laparoscopic antireflux surgery (LARS). Surg Endosc 2003, 17:2003–2011.

    Article  PubMed  CAS  Google Scholar 

  47. Perez AR, Moncure AC, Rattner DW: Obesity adversely affects the outcome of antireflux operations. Surg Endosc 2001, 15:986–989.

    Article  PubMed  CAS  Google Scholar 

  48. D’Alessio MJ, Arnaoutakis D, Giarelli N, et al.: Obesity is not a contraindication to laparoscopic Nissen fundoplication. J Gastrointest Surg 2005, 9:949–954.

    Article  PubMed  Google Scholar 

  49. Anvari M, Bamehriz F: Outcome of laparoscopic Nissen fundoplication in patients with body mass index > or = 35. Surg Endosc 2006, 20:230–234.

    Article  PubMed  CAS  Google Scholar 

  50. Bredenoord AJ, Weusten BL, Timmer R, Smout AJ: Air swallowing, belching, and reflux in patients with gastroesophageal reflux disease. Am J Gastroenterol 2006, 101:1721–1726.

    Article  PubMed  Google Scholar 

  51. Oleynikov D, Oelschlager B: New alternatives in the management of gastroesophageal reflux disease. Am J Surg 2003, 186:106–111.

    Article  PubMed  Google Scholar 

  52. Hogan WJ: Clinical trials evaluating endoscopic GERD treatments: is it time for a moratorium on the clinical use of these procedures? Am J Gastroenterol 2006, 101:437–439.

    Article  PubMed  Google Scholar 

  53. Wakelin DE, Sampliner RE: Endoscopic antireflux procedures: a good wrap? Clin Gastroenterol Hepatol 2005, 3:831–839.

    Article  PubMed  Google Scholar 

  54. Lundell L: Complications after anti-reflux surgery. Best Pract Res Clin Gastroenterol 2004, 18:935–945.

    PubMed  CAS  Google Scholar 

  55. Perdikis G, Hinder RA, Lund RJ, et al.: Laparoscopic Nissen fundoplication: where do we stand? Surg Laparosc Endosc 1997, 7:17–21.

    Article  PubMed  CAS  Google Scholar 

  56. Zacharoulis D, O’Boyle CJ, Sedman PC, et al.: Laparoscopic fundoplication: a 10-year learning curve. Surg Endosc 2006, 20:1662–1670.

    Article  PubMed  CAS  Google Scholar 

  57. Scheffer RC, Samsom M, Haverkamp A, et al.: Impaired bolus transit across the esophagogastric junction in postfundoplication dysphagia. Am J Gastroenterol 2005, 100:1677–1684.

    Article  PubMed  CAS  Google Scholar 

  58. Poulin EC, Diamant NE, Kortan P, et al.: Achalasia developing years after surgery for reflux disease: case reports, laparoscopic treatment, and review of achalasia syndromes following antireflux surgery. J Gastrointest Surg 2000, 4:626–631.

    Article  PubMed  CAS  Google Scholar 

  59. Stylopoulos N, Bunker CJ, Rattner DW: Development of achalasia secondary to laparoscopic Nissen fundoplication. J Gastrointest Surg 2002, 6:368–376; discussion 377–378.

    Article  PubMed  Google Scholar 

  60. Waring JP: Postfundoplication complications. Prevention and management. Gastroenterol Clin North Am 1999, 28:1007–1019, viii–ix.

    Article  PubMed  CAS  Google Scholar 

  61. Karamanolis G, Sgouros S, Karatzias G, et al.: Long-term outcome of pneumatic dilation in the treatment of achalasia. Am J Gastroenterol 2005, 100:270–274.

    Article  PubMed  Google Scholar 

  62. Kadakia SC, Wong RK: Pneumatic balloon dilation for esophageal achalasia. Gastrointest Endosc Clin N Am 2001, 11:325–346, vii.

    PubMed  CAS  Google Scholar 

  63. Gaudric M, Sabate JM, Artru P, et al.: Results of pneumatic dilatation in patients with dysphagia after antireflux surgery. Br J Surg 1999, 86:1088–1091.

    Article  PubMed  CAS  Google Scholar 

  64. Hui JM, Hunt DR, de Carle DJ, et al.: Esophageal pneumatic dilation for postfundoplication dysphagia: safety, efficacy, and predictors of outcome. Am J Gastroenterol 2002, 97:2986–2991.

    Article  PubMed  CAS  Google Scholar 

  65. Wo JM, Trus TL, Richardson WS, et al.: Evaluation and management of postfundoplication dysphagia. Am J Gastroenterol 1996, 91:2318–2322.

    PubMed  CAS  Google Scholar 

  66. Ellingson TL, Kozarek RA, Gelfand MD, et al.: Iatrogenic achalasia. A case series. J Clin Gastroenterol 1995, 20:96–99.

    Article  PubMed  CAS  Google Scholar 

  67. Granderath FA, Schweiger UM, Kamolz T, Pointner R: Dysphagia after laparoscopic antireflux surgery: a problem of hiatal closure more than a problem of the wrap. Surg Endosc 2005, 19:1439–1446.

    Article  PubMed  CAS  Google Scholar 

  68. Malhi-Chowla N, Gorecki P, Bammer T, et al.: Dilation after fundoplication: timing, frequency, indications, and outcome. Gastrointest Endosc 2002, 55:219–223.

    Article  PubMed  Google Scholar 

  69. Wong RK: Pneumatic dilation for achalasia. Am J Gastroenterol 2004, 99:578–580.

    Article  PubMed  Google Scholar 

  70. Hunt DR, Wills VL, Weis B, et al.: Management of esophageal perforation after pneumatic dilation for achalasia. J Gastrointest Surg 2000, 4:411–415.

    Article  PubMed  CAS  Google Scholar 

  71. Metman EH, Lagasse JP, d’Alteroche L, et al.: Risk factors for immediate complications after progressive pneumatic dilation for achalasia. Am J Gastroenterol 1999, 94:1179–1185.

    Article  PubMed  CAS  Google Scholar 

  72. Friedenberg F, Gollamudi S, Parkman HP: The use of botulinum toxin for the treatment of gastrointestinal motility disorders. Dig Dis Sci 2004, 49:165–175.

    Article  PubMed  CAS  Google Scholar 

  73. Zaninotto G, Annese V, Costantini M, et al.: Randomized controlled trial of botulinum toxin versus laparoscopic Heller myotomy for esophageal achalasia. Ann Surg 2004, 239:364–370.

    Article  PubMed  Google Scholar 

  74. Vaezi MF, Richter JE, Wilcox CM, et al.: Botulinum toxin versus pneumatic dilatation in the treatment of achalasia: a randomised trial. Gut 1999, 44:231–239.

    Article  PubMed  CAS  Google Scholar 

  75. Muehldorfer SM, Schneider TH, Hochberger J, et al.: Esophageal achalasia: intrasphincteric injection of botulinum toxin A versus balloon dilation. Endoscopy 1999, 31:517–521.

    Article  PubMed  CAS  Google Scholar 

  76. Annese V, Bassotti G, Coccia G, et al.: A multicentre randomised study of intrasphincteric botulinum toxin in patients with oesophageal achalasia. GISMAD Achalasia Study Group. Gut 2000, 46:597–600.

    Article  PubMed  CAS  Google Scholar 

  77. Martinek J, Siroky M, Plottova Z, et al.: Treatment of patients with achalasia with botulinum toxin: a multicenter prospective cohort study. Dis Esophagus 2003, 16:204–209.

    Article  PubMed  CAS  Google Scholar 

  78. Forouzesh A, White KT, Mullin GE: The development of pneumoperitoneum as a result of Botox injection for the treatment of achalasia. Am J Gastroenterol 2003, 98:5546.

    Article  Google Scholar 

  79. Eaker EY, Gordon JM, Vogel SB: Untoward effects of esophageal botulinum toxin injection in the treatment of achalasia. Dig Dis Sci 1997, 42:724–727.

    Article  PubMed  CAS  Google Scholar 

  80. Horgan S, Hudda K, Eubanks T, et al.: Does botulinum toxin injection make esophagomyotomy a more difficult operation? Surg Endosc 1999, 13:576–579.

    Article  PubMed  CAS  Google Scholar 

  81. Gadenstatter M, Hagen JA, DeMeester TR, et al.: Esophagectomy for unsuccessful antireflux operations. J Thorac Cardiovasc Surg 1998, 115:296–300, 302; discussion 300–301.

    Article  PubMed  CAS  Google Scholar 

  82. Sayuk GS, Clouse RE: Management of esophageal symptoms following fundoplication. Curr Treat Options Gastroenterol 2005, 8:293–303.

    Article  PubMed  Google Scholar 

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  1. Division of Gastroenterology, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8124, St. Louis, MO, 63110, USA

    Gregory S. Sayuk

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  2. Ray E. Clouse
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Correspondence to Gregory S. Sayuk.

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Sayuk, G.S., Clouse, R.E. Esophageal symptoms following antireflux surgery: Issues and management. Curr GERD Rep 1, 41–49 (2007). https://doi.org/10.1007/s12171-007-0033-x

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