Do patients with gastroesophageal reflux disease and somatoform tendencies benefit from antireflux surgery?  

作　　者：Hans Friedrich Fuchs Benjamin Babic Karl-Hermann Fuchs Wolfram Breithaupt Gabor Varga Frauke Musial 

机构地区：[1]Department of General Surgery, University of Cologne [2]Department of General Surgery, University of Mainz [3]Department of Surgery, University of California San Diego [4]Department of Surgery, Goethe University Frankfurt [5]National Research Center in Complementary and Alternative Medicine,NAFKAM [6]Department of Community Medicine, UiT, The Arctic University of Norway

出　　处：《World Journal of Gastroenterology》2019年第3期388-397,共10页世界胃肠病学杂志（英文版）

摘　　要：BACKGROUND The clinical presentation of gastroesophageal reflux disease(GERD) shows a large symptom variation also in different intensities among patients. As several studies have shown, there is a large overlap in the symptomatic spectrum between proven GERD and other disorders such as dyspepsia, functional heartburn and/or somatoform disorders.AIM To prospectively evaluate the GERD patients with and without somatoform disorders before and after laparoscopic antireflux surgery.METHODS In a tertiary referral center for foregut surgery over a period of 3 years patients with GERD, qualifying for the indication of laparoscopic antireflux surgery, were investigated prospectively regarding their symptomatic spectrum in order to identify GERD and associated somatoform disorders. Assessment of symptoms was performed by an instrument for the evaluation of somatoform disorders[Somatoform Symptom Index(SSI) > 17]. Quality of life was evaluated by Gastrointestinal Quality of Life Index(GIQLI).RESULTS In 123 patients an indication for laparoscopic antireflux surgery was established and in 43 patients further medical therapy was suggested. The portion of somatoform tendencies in the total patient population was 20.48%(34 patients).Patients with a positive SSI had a preoperative GIQLI of 77(32-111). Patients with a normal SSI had a GIQLI of 105(29-140)(P < 0.0001). In patients with GERD the quality of life could be normalized from preoperative reduced values of GIQLI102(47-140) to postoperative values of 117(44-144). In patients with GERD and somatoform disorders, the GIQLI was improved from preoperative GIQLI 75(47-111) to postoperative 95(44-122)(P < 0.0043).CONCLUSION Patients with GERD and associated somatoform disorders have significantly worse levels of quality of life. The latter patients can also benefit from laparoscopic fundoplication, however they will not reach a normal level.BACKGROUND The clinical presentation of gastroesophageal reflux disease(GERD) shows a large symptom variation also in different intensities among patients. As several studies have shown, there is a large overlap in the symptomatic spectrum between proven GERD and other disorders such as dyspepsia, functional heartburn and/or somatoform disorders.AIM To prospectively evaluate the GERD patients with and without somatoform disorders before and after laparoscopic antireflux surgery.METHODS In a tertiary referral center for foregut surgery over a period of 3 years patients with GERD, qualifying for the indication of laparoscopic antireflux surgery, were investigated prospectively regarding their symptomatic spectrum in order to identify GERD and associated somatoform disorders. Assessment of symptoms was performed by an instrument for the evaluation of somatoform disorders[Somatoform Symptom Index(SSI) > 17]. Quality of life was evaluated by Gastrointestinal Quality of Life Index(GIQLI).RESULTS In 123 patients an indication for laparoscopic antireflux surgery was established and in 43 patients further medical therapy was suggested. The portion of somatoform tendencies in the total patient population was 20.48%(34 patients).Patients with a positive SSI had a preoperative GIQLI of 77(32-111). Patients with a normal SSI had a GIQLI of 105(29-140)(P < 0.0001). In patients with GERD the quality of life could be normalized from preoperative reduced values of GIQLI102(47-140) to postoperative values of 117(44-144). In patients with GERD and somatoform disorders, the GIQLI was improved from preoperative GIQLI 75(47-111) to postoperative 95(44-122)(P < 0.0043).CONCLUSION Patients with GERD and associated somatoform disorders have significantly worse levels of quality of life. The latter patients can also benefit from laparoscopic fundoplication, however they will not reach a normal level.

关 键 词：GASTROESOPHAGEAL REFLUX DISEASE ANTIREFLUX surgery Laparoscopic fundoplication SOMATIZATION GASTROESOPHAGEAL REFLUX DISEASE symptoms 

分 类 号：R[医药卫生]