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Yao P, Liao X, Huang J, Dang Y, Jiang H. Identifying causal relationships between gastroesophageal reflux and extraesophageal diseases: A Mendelian randomization study. Medicine (Baltimore) 2024; 103:e37054. [PMID: 38363933 PMCID: PMC10869099 DOI: 10.1097/md.0000000000037054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 01/03/2024] [Indexed: 02/18/2024] Open
Abstract
Traditional observational and in vivo studies have suggested an etiological link between gastroesophageal reflux disease (GERD) and the development of extraesophageal diseases (EEDs), such as noncardiac chest pain. However, evidence demonstrating potential causal relationships is lacking. This study evaluated the potential causal relationship between GERD and EEDs, including throat and chest pain, asthma, bronchitis, chronic rhinitis, nasopharyngitis and pharyngitis, gingivitis and periodontal disease, cough, using multiple Mendelian randomization (MR) methods, and sensitivity analysis was performed. The Mendelian randomization Pleiotropy RESidual Sum and Outlier and PhenoScanner tools were used to further check for heterogeneous results and remove outliers. MR with inverse-variance weighted (IVW) showed a significant causal relationship between GERD and EEDs after Bonferroni correction. IVW results indicated that GERD increased the risk of chronic rhinitis, nasopharyngitis and pharyngitis (odds ratio [OR] = 1.482, 95% confidence interval [CI] = 1.267-1.734, P < .001], gingivitis and periodontal disease (OR = 1.166, 95% CI = 1.046-1.190, P = .001), throat and chest pain (OR = 1.585, 95% CI = 1.455-1.726, P < .001), asthma (OR = 1.539, 95% CI = 1.379-1.717, P < .001), and bronchitis (OR = 1.249, 95% CI = 1.168-1.335, P < .001). Sensitivity analysis did not detect pleiotropy. Leave-one-out analysis shows that MR results were not affected by individual single nucleotide polymorphisms. The funnel plot considers the genetic instrumental variables to be almost symmetrically distributed. This MR supports a causal relationship among GERD and EEDs. Precise moderation based on causality and active promotion of collaboration among multidisciplinary physicians ensure high-quality diagnostic and treatment recommendations and maximize patient benefit.
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Affiliation(s)
- Peishan Yao
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xiaomin Liao
- Guangxi Medical University, Nanning, Guangxi, China
| | - Junming Huang
- The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - Yi Dang
- Department of Gastroenterology, Yulin Red Cross Hospital, Yulin, Guangxi, China
| | - Haixing Jiang
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
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2
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Wang Y, Lv Y, Liu Y, Xie C. The effect of surgical repair of hiatal hernia (HH) on pulmonary function: a systematic review and meta-analysis. Hernia 2023:10.1007/s10029-023-02756-5. [PMID: 36826630 PMCID: PMC10374806 DOI: 10.1007/s10029-023-02756-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/13/2023] [Indexed: 02/25/2023]
Abstract
PURPOSE Hiatal hernia is renowned for the symptom of reflux, and few physicians associate a hiatal hernia with pulmonary issues. It is widely acknowledged that a hiatal hernia can be treated with surgery. However, less is known about how the surgical procedure would benefit pulmonary function. Thus, the aim of this study was to determine whether surgical repair can improve pulmonary function in patients with hiatal hernias. METHODS We registered the protocol on the PROSPERO (International Prospective Register of Systematic Reviews) platform (no. CRD42022369949). We searched the PubMed, Embase, Cochrane Library, and ClinicalTrials.gov databases for cohort studies that reported on the pulmonary function of patients with hiatal hernias. The quality of each cohort study was evaluated using the Newcastle-Ottawa scale (NOS). We then calculated mean differences (MDs) with 95% confidence intervals for these continuous outcomes. Each study's consistency was appraised using the I2 statistic. The sensitivity analysis was performed using the trim-and-fill method. Publication bias was confirmed using the funnel plot visually and Egger regression test statistically. RESULTS A total of 262 patients from 5 cohorts were included in the meta-analysis. The quality evaluation revealed that, of these 5 papers, 3 received 8 NOS stars out of 9 stars, 1 received 9, and the other received 7, meaning all included cohort studies were of high quality. The results showed that surgical repair for a hiatal hernia significantly improved forced expiratory volume in 1 s (FEV1; weighted mean difference [WMD]:0.200; 95% CI 0.047-0.353; I2 = 71.6%; P = 0.010), forced vital capacity (FVC; WMD: 0.242; 95% CI 0.161-0.323; I2 = 7.1%; P = 0.000), and total lung capacity (TLC; WMD: 0.223; 95% CI 0.098-0.348; I2 = 0.0%; P = 0.000) but had little effect on residual volume (RV; WMD: -0.028; 95% CI -0.096 to 0.039; I2 = 8.7%; P = 0.411) and the diffusing capacity carbon monoxide (DLCO; WMD: 0.234; 95% CI -0.486 to 0.953; I2 = 0.0%; P = 0.524). CONCLUSION For individuals with hiatal hernias, surgical repair is an efficient technique to improve respiratory function as measured by FEV1, FVC, and TLC.
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Affiliation(s)
- Y Wang
- General Surgery Department, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China.
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Y Lv
- General Surgery Department, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Y Liu
- General Surgery Department, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - C Xie
- General Surgery Department, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
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Li ZT, Kong XL, Zhang R, Yao JN, Li CX, Han XW, Wang ZG, Liu KD, Ji F. Laparoscopic antireflux surgery or PPIs in the management of reflux-related esophageal stricture. Surg Endosc 2023; 37:1077-1085. [PMID: 36109360 PMCID: PMC9944358 DOI: 10.1007/s00464-022-09564-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 08/14/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) is often associated with esophageal stricture, particularly benign esophageal stricture. We aimed to evaluate the effects of balloon catheter dilation (BD) combined with laparoscopic fundoplication (LF) surgery and proton pump inhibitors (PPIs) in patients with reflux-induced esophageal strictures. METHODS We retrospectively analyzed 116 patients with reflux-induced benign esophageal strictures who underwent balloon dilatation therapy combined with PPIs (BD-PPIs group, n = 58) and balloon dilatation combined with LF (BD-LF group, n = 58). Patients were followed up for 24 months. The outcomes of the patients were monitored, including clinical success, symptom improvement, adverse events, and the frequency of esophagitis. RESULTS At the latest follow-up, the rate of clinical success was higher in BD-LF group than in BD-PPIs group (80.4% vs. 57.7%, P = 0.011). The patients in the BD-PPIs group required more dilation sessions to achieve successful dilation, as compared to those in the BD-LF group (2.1 ± 1.2 vs. 0.7 ± 0.8, P < 0.001). The DeMeester score, number of reflux episodes for which pH was < 4, and lower esophageal sphincter pressure were significantly better in the BD-LF group than in the BD-PPIs group (all P < 0.001). The incidence of reflux esophagitis was higher in the BD-PPIs group than in the BD-LF group, at 24 months (58.8% vs. 18.2%, P = 0.003). CONCLUSIONS Balloon dilatation with concomitant LF is effective and safe for esophageal stricture secondary to GERD. Moreover, antireflux surgery techniques, such as Nissen or Toupet procedure, should be added for reflux-induced benign esophageal stricture.
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Affiliation(s)
- Zhi-Tong Li
- Department of Gastroenterology, The First Affiliated Hospital, Zhengzhou University, No. 1, East Jian She Road, Zhengzhou, 450052, Henan Province, People's Republic of China
| | - Xiang-Lin Kong
- Shandong University of Traditional Chinese Medicine, No. 4655, University Road, Jinan, 250355, Shandong Province, People's Republic of China
| | - Rui Zhang
- Department of Respiratory and Critical Medicine, The First Affiliated Hospital, Zhengzhou University, No. 1, East Jian She Road, Zhengzhou, 450052, Henan Province, People's Republic of China
| | - Jian-Ning Yao
- Department of Gastroenterology, The First Affiliated Hospital, Zhengzhou University, No. 1, East Jian She Road, Zhengzhou, 450052, Henan Province, People's Republic of China
| | - Chun-Xia Li
- Department of Interventional Radiology, The First Affiliated Hospital, Zhengzhou University, No. 1, East Jian She Road, Zhengzhou, 450052, Henan Province, People's Republic of China
| | - Xin-Wei Han
- Department of Interventional Radiology, The First Affiliated Hospital, Zhengzhou University, No. 1, East Jian She Road, Zhengzhou, 450052, Henan Province, People's Republic of China
| | - Zhong-Gao Wang
- Department of Gastroenterology, The First Affiliated Hospital, Zhengzhou University, No. 1, East Jian She Road, Zhengzhou, 450052, Henan Province, People's Republic of China
| | - Kang-Dong Liu
- School of Basic Medical Science, Zhengzhou University, Zhengzhou, 450001, Henan Province, People's Republic of China
| | - Feng Ji
- Department of Gastroenterology, The First Affiliated Hospital, Zhengzhou University, No. 1, East Jian She Road, Zhengzhou, 450052, Henan Province, People's Republic of China.
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Myers D, Jacobson X, Dale M, Sahasranaman V, Nandipati K. Impact of Paraesophageal Hernia Repair on Respiratory Function: A Systematic Review. Front Surg 2021; 8:666686. [PMID: 34262930 PMCID: PMC8273160 DOI: 10.3389/fsurg.2021.666686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/29/2021] [Indexed: 01/23/2023] Open
Abstract
Background and Objectives: Surgical repair of hiatal and paraesophageal hernia is widely accepted for the treatment of gastroesophageal reflux symptoms. The respiratory benefit of this surgery is less clear. The objective of this review is to quantify the benefit to pulmonary function and subjective dyspnea of paraesophageal hernia repair with the aim of refining the indications and contraindications for elective paraesophageal hernia repair. Methods: Articles were gathered from systematic searches of the Medline Complete Database via the Creighton University Health Sciences Library literature search services. Publications with both pre and postoperative pulmonary function data or both pre and postoperative subjective dyspnea data with regards to surgical paraesophageal hernia repair were included. Results: Six studies were included in this review. The majority of studies in this review show improvement in pulmonary function postoperatively with regards to FEV1, FVC, and VC when stratified by % intrathoracic stomach (ITS), particularly in groups >50% ITS. No significant change was seen in postoperative DLCO or FEV1/FVC. Conclusion: Paraesophageal hernia repair has shown to improve pulmonary function both objectively and subjectively. This review was limited by the paucity of literature on the subject as well as the lack of a standardized method for measurement of %ITS.
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Affiliation(s)
- Dominick Myers
- School of Medicine, Creighton University, Omaha, NE, United States
| | - Xander Jacobson
- School of Medicine, Creighton University, Omaha, NE, United States
| | - Matthew Dale
- Department of Surgery, School of Medicine, Creighton University, Omaha, NE, United States
| | - Venket Sahasranaman
- Department of Pulmonology, School of Medicine, Creighton University, Omaha, NE, United States
| | - Kalyana Nandipati
- Department of Surgery, School of Medicine, Creighton University, Omaha, NE, United States
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Endoscopic cardial constriction with band ligation in the treatment of refractory gastroesophageal reflux disease: a preliminary feasibility study. Surg Endosc 2021; 35:4035-4041. [PMID: 33881623 PMCID: PMC8195937 DOI: 10.1007/s00464-021-08397-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 02/12/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) is a common digestive disease, could cause extra-esophageal symptoms. Peroral endoscopic cardial constriction with band ligation (PECC-b) is a minimally invasive method for the treatment of GERD in recent years. The goals of this study were to evaluate the clinical efficacy of PECC-b to treat gastroesophageal reflux-related symptoms. METHODS A retrospective study of patients undergoing PECC-b between January 2017 and December 2018 at a single institution was conducted. All patients confirmed GERD by endoscopy, esophageal PH-impedance monitoring, esophageal manometry and symptom questionnaires. The outcome measures included reflux-related scores, patients' satisfaction and drug independence after 12 months following surgery. RESULTS A total of 68 patients, with follow-up of 12 months post surgery, were included in the final analysis. The symptom scores were all significantly decreased as compared with preoperation (P < 0.05). The esophageal symptom scores showed a better improvement than extra-esophageal symptoms (P < 0.001). Fifty-three (77.9%) patients achieved complete drug therapy independence and 52 (76.5%) patients were completely or partially satisfied with the symptom relief following surgery. CONCLUSIONS The PECC-b is a safe, effective and recommended approach for the control of GERD-related symptoms. Further multicenter prospective studies are required to confirm these outcomes.
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6
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Combustion-derived particles from biomass sources differently promote epithelial-to-mesenchymal transition on A549 cells. Arch Toxicol 2021; 95:1379-1390. [PMID: 33481051 PMCID: PMC8032642 DOI: 10.1007/s00204-021-02983-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 01/06/2021] [Indexed: 01/26/2023]
Abstract
Combustion-derived particles (CDPs), due to the presence in their composition of several toxic and carcinogenic chemical compounds, such as polycyclic aromatic hydrocarbons (PAHs) and metals, are linked to several respiratory diseases, including lung cancer. Epithelial-to-mesenchymal transition (EMT) is a crucial step in lung cancer progression, involving several morphological and phenotypical changes. The study aims to investigate how exposure to CDPs from different biomass sources might be involved in cancer development, focusing mainly on the effects linked to EMT and invasion on human A549 lung cells. Biomass combustion-derived particles (BCDPs) were collected from a stove fuelled with pellet, charcoal or wood, respectively. A time course and dose response evaluation on cell viability and pro-inflammatory response was performed to select the optimal conditions for EMT-related studies. A significant release of IL-8 was found after 72 h of exposure to 2.5 μg/cm2 BCDPs. The EMT activation was then examined by evaluating the expression of some typical markers, such as E-cadherin and N-cadherin, and the possible enhanced migration and invasiveness. Sub-acute exposure revealed that BCDPs differentially modulated cell viability, migration and invasion, as well as the expression of proteins linked to EMT. Results showed a reduction in the epithelial marker E-cadherin and a parallel increase in the mesenchymal markers N-cadherin, mainly after exposure to charcoal and wood. Migration and invasion were also increased. In conclusion, our results suggest that BCDPs with a higher content of organic compounds (e.g. PAHs) in their chemical composition might play a crucial role in inducing pro-carcinogenic effects on epithelial cells.
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7
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McDonnell MJ, Hunt EB, Ward C, Pearson JP, O'Toole D, Laffey JG, Murphy DM, Rutherford RM. Current therapies for gastro-oesophageal reflux in the setting of chronic lung disease: state of the art review. ERJ Open Res 2020; 6:00190-2019. [PMID: 33693049 PMCID: PMC7927787 DOI: 10.1183/23120541.00190-2019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 08/12/2020] [Indexed: 12/13/2022] Open
Abstract
The inter-relationship between chronic respiratory disease and reflux disease in the airway reflux paradigm is extremely complex and remains poorly characterised. Reflux disease is reported to cause or contribute to the severity of a number of respiratory tract diseases including laryngeal disorders, sinusitis, chronic cough, asthma, COPD, idiopathic pulmonary fibrosis, cystic fibrosis, bronchiectasis and bronchiolitis obliterans post lung transplant. It is now appreciated that reflux disease is not simply caused by liquid acid reflux but rather by a variety of chemical refluxates originating from the stomach and duodenum due to a number of different mechanisms. Reflux disease can be challenging to diagnose, particularly proving its role in the causation of direct respiratory epithelial damage. Significant advances in oesophageal assessment and gastric biomarkers have emerged in recent years as our understanding increases. There are a number of treatments available for reflux disease, both medical and surgical, but there is a paucity of large randomised trials to evaluate their efficacy in the setting of chronic respiratory disease. Everyday clinical practice, however, informs us that treatment failure in reflux disease is common. This clinical review summarises associations between reflux disease in the setting of chronic respiratory diseases and examines available evidence regarding potential therapeutic strategies. Gastro-oesophageal reflux disease is prevalent among patients with chronic respiratory disease. A number of medical and surgical treatment options are available for GORD. This review examines available evidence in the setting of chronic lung disease.https://bit.ly/34TcMJS
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Affiliation(s)
- Melissa J McDonnell
- Dept of Respiratory Medicine, Galway University Hospitals, Galway, Ireland.,Lung Biology Group, National University of Ireland, Galway, Ireland.,Institute of Cell and Molecular Biosciences, Newcastle University, Newcastle, UK
| | - Eoin B Hunt
- Dept of Respiratory Medicine, Cork University Hospital, Cork, Ireland.,The Clinical Research Facility, University College Cork, Cork, Ireland
| | - Chris Ward
- Institute of Cell and Molecular Biosciences, Newcastle University, Newcastle, UK
| | - Jeffrey P Pearson
- Institute of Cell and Molecular Biosciences, Newcastle University, Newcastle, UK
| | - Daniel O'Toole
- Lung Biology Group, National University of Ireland, Galway, Ireland
| | - John G Laffey
- Lung Biology Group, National University of Ireland, Galway, Ireland
| | - Desmond M Murphy
- Dept of Respiratory Medicine, Cork University Hospital, Cork, Ireland.,The Clinical Research Facility, University College Cork, Cork, Ireland
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Tustumi F, Bernardo WM, Mariano da Rocha JR, Szachnowicz S, Bernal da Costa Seguro FC, Bianchi ET, Takeda FR, Afonso de Miranda Neto A, Aissar Sallum RA, Cecconello I. Anti-reflux surgery for controlling respiratory symptoms of gastro-esophageal reflux disease: A systematic review and meta-analysis. Asian J Surg 2020; 44:2-10. [PMID: 32534727 DOI: 10.1016/j.asjsur.2020.04.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 03/15/2020] [Accepted: 04/05/2020] [Indexed: 02/08/2023] Open
Abstract
Gastro-esophageal reflux disease (GERD) patients have a higher prevalence of airway symptoms, such as chronic cough, wheezing, and hoarseness. The therapeutic management of patients with these symptoms is controversial. Therefore, this study aims to perform a systematic review and meta-analysis evaluating the efficacy of anti-reflux surgery for controlling respiratory symptoms related to GERD. A systematic review and meta-analysis was performed. Extraction of the data concerning proportions of participants who were not free of respiratory symptoms related to GERD (cough, wheezing, hoarseness) or not substantially improved at follow-ups (failure to cure) was performed. Of the 3,424 initially screened articles, 68 studies were included for systematic review and 61 were included for meta-analysis, with a cumulative sample size of 3,869 patients. Of all the included patients, after anti-reflux surgery, the general symptoms improvement was 80% (95% CI 75.2-84%). The numbers needed to harm (NNH) and the numbers needed to treat (NNT) were 15.21 and 1.23, respectively. Of the included patients, 83.4% (95% CI 78.3-87.5%) patients reported improvement in cough symptoms after surgery. For the wheezing symptom, 71.5% (95% CI 62.9-78.8%) reported improvement after surgery. Moreover, surgery presented better results in improving respiratory symptoms than medical therapy (risk difference: -0.46; 95% CI -0.77, -0.16). Physicians should strongly consider surgical anti-reflux procedures for controlling respiratory symptoms in GERD patients after proper patient selection. Anti-reflux surgery has shown high efficacy in improving respiratory symptoms related to GERD, even when compared to medical therapy.
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Affiliation(s)
- Francisco Tustumi
- Department of Gastroenterology, Digestive Surgery Division, University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, São Paulo, SP, 05403-000, Brazil.
| | - Wanderley Marques Bernardo
- Department of Gastroenterology, Digestive Surgery Division, University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, São Paulo, SP, 05403-000, Brazil
| | - Julio Rafael Mariano da Rocha
- Department of Gastroenterology, Digestive Surgery Division, University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, São Paulo, SP, 05403-000, Brazil
| | - Sérgio Szachnowicz
- Department of Gastroenterology, Digestive Surgery Division, University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, São Paulo, SP, 05403-000, Brazil
| | | | - Edno Tales Bianchi
- Department of Gastroenterology, Digestive Surgery Division, University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, São Paulo, SP, 05403-000, Brazil
| | - Flávio Roberto Takeda
- Department of Gastroenterology, Digestive Surgery Division, University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, São Paulo, SP, 05403-000, Brazil
| | - Antonio Afonso de Miranda Neto
- Department of Gastroenterology, Digestive Surgery Division, University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, São Paulo, SP, 05403-000, Brazil
| | - Rubens Antonio Aissar Sallum
- Department of Gastroenterology, Digestive Surgery Division, University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, São Paulo, SP, 05403-000, Brazil
| | - Ivan Cecconello
- Department of Gastroenterology, Digestive Surgery Division, University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, São Paulo, SP, 05403-000, Brazil
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9
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Li ZT, Ji F, Han XW, Yuan LL, Wu ZY, Xu M, Peng DL, Wang ZG. Role of fundoplication in treatment of patients with symptoms of hiatal hernia. Sci Rep 2019; 9:12544. [PMID: 31467314 PMCID: PMC6715856 DOI: 10.1038/s41598-019-48740-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 07/25/2019] [Indexed: 12/12/2022] Open
Abstract
Gastroesophageal reflux disease (GERD) is often associated with hiatal hernia (HH). However, the need for fundoplication during hiatal hernia repair (HHR) remains controversial. The objective of this study was to evaluate the effect of HHR with concomitant laparoscopic Nissen fundoplication (HHR-LNF) in HH patients. A total of 122 patients with symptomatic HH were randomized to receive either HHR (n = 61) or HHR-LNF (n = 61). The measures of evaluating outcomes included DeMeester scores (DMS), complications, Reflux Diagnostic Questionnaire and patients' satisfaction 24 months following surgery. Despite comparable values in both groups at randomization, the DMS, total numbers of reflux episodes and percentage of time with pH < 4 were significantly higher in HHR group than in HHR-LNF group (P = 0.017, P = 0.002 and P = 0.019, respectively) at 6 months after surgery. One months postoperatively, complications were higher in the HHR-LNF group than in the HHR group (all P < 0.001), and there was no difference between the two groups at 6 months. By the end of the 2-year follow-up, HHR-LNF group showed a significantly lower reflux syndrome frequency-intensity score and greater percentage of satisfaction compared with HHR group (all P < 0.001). Laparoscopic HHR should be combined with a fundoplication in GERD patients with HH. HHR-LNF is safe and effective, not only improve reflux-related symptom, but also reduce the incidence of complications.
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Affiliation(s)
- Zhi-Tong Li
- Department of Interventional Radiology, The First Affiliated Hospital, Zhengzhou University, No. 1, East Jian She Road, Zhengzhou, 450052, Henan Province, People's Republic of China
| | - Feng Ji
- Department of Interventional Radiology, The First Affiliated Hospital, Zhengzhou University, No. 1, East Jian She Road, Zhengzhou, 450052, Henan Province, People's Republic of China.
| | - Xin-Wei Han
- Department of Interventional Radiology, The First Affiliated Hospital, Zhengzhou University, No. 1, East Jian She Road, Zhengzhou, 450052, Henan Province, People's Republic of China.
| | - Li-Li Yuan
- Department of Interventional Radiology, The First Affiliated Hospital, Zhengzhou University, No. 1, East Jian She Road, Zhengzhou, 450052, Henan Province, People's Republic of China
| | - Zheng-Yang Wu
- Department of Interventional Radiology, The First Affiliated Hospital, Zhengzhou University, No. 1, East Jian She Road, Zhengzhou, 450052, Henan Province, People's Republic of China
| | - Miao Xu
- Department of Interventional Radiology, The First Affiliated Hospital, Zhengzhou University, No. 1, East Jian She Road, Zhengzhou, 450052, Henan Province, People's Republic of China
| | - De-Lu Peng
- Department of Interventional Radiology, The First Affiliated Hospital, Zhengzhou University, No. 1, East Jian She Road, Zhengzhou, 450052, Henan Province, People's Republic of China
| | - Zhong-Gao Wang
- Department of Interventional Radiology, The First Affiliated Hospital, Zhengzhou University, No. 1, East Jian She Road, Zhengzhou, 450052, Henan Province, People's Republic of China
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