Symptoms are a poor indicator of reflux status after fundoplication for gastroesophageal reflux disease: role of esophageal functions tests

Arch Surg. 2003 May;138(5):514-8; discussion 518-9. doi: 10.1001/archsurg.138.5.514.


Background: If a patient develops foregut symptoms after a fundoplication, it is assumed that the operation has failed, and acid-reducing medications are often prescribed. Esophageal function tests (manometry and pH monitoring) are seldom performed early in the management of these patients.

Hypothesis: In patients who are symptomatic after fundoplication for gastroesophageal reflux disease, a symptom-based diagnosis is not accurate, and esophageal function tests should be performed routinely before starting acid-reducing medications.

Design: Prospective study.

Setting: University hospital.

Patients and methods: One hundred twenty-four patients who developed foregut symptoms after laparoscopic fundoplication (average, 17 months postoperatively) underwent esophageal manometry and pH monitoring. Sixty-two patients (50%) were taking acid-reducing medications.

Main outcome measures: Postoperative symptoms, use of antireflux medications, grade of esophagitis, esophageal motility, and DeMeester scores.

Results: Seventy-six (61%) of the 124 patients had normal esophageal acid exposure, while the acid exposure was abnormal in 48 patients (39%). Only 20 (32%) of the 62 patients who were taking acid-reducing medications had reflux postoperatively. Regurgitation was the only symptom that predicted abnormal reflux.

Conclusions: These results show that (1) symptoms were due to reflux in 39% of patients only; (2) with the exception of regurgitation, symptoms were an unreliable index of the presence of reflux; and (3) 68% of patients who were taking acid-reducing medications postoperatively had a normal reflux status. Esophageal function tests should be performed early in the evaluation of patients after fundoplication to avoid improper and costly medical therapy.

MeSH terms

  • Adult
  • Female
  • Fundoplication*
  • Gastroesophageal Reflux / diagnosis*
  • Gastroesophageal Reflux / surgery*
  • Humans
  • Hydrogen-Ion Concentration
  • Male
  • Manometry
  • Middle Aged
  • Monitoring, Physiologic
  • Prospective Studies
  • Recurrence