Recurrent symptoms after fundoplication with a negative pH study--recurrent reflux or functional heartburn?

J Gastrointest Surg. 2009 Jan;13(1):54-60. doi: 10.1007/s11605-008-0653-1. Epub 2008 Aug 20.


Introduction: A small cohort of patients present after antireflux surgery complaining of recurrent heartburn. Over two thirds of these patients will have a negative 24-h pH study. The aim of our study is to determine whether these patients have an associated functional disorder or abnormal cytokine activity and to examine the reproducibility of pH testing.

Methods: A prospective analysis was carried out on a cohort of patients who had undergone a fundoplication and postoperative pH testing for recurrent heartburn: group A--patients with recurrent heartburn and a negative 24-h pH study and group B (control group)--patients with recurrent heartburn and a positive pH study. Questionnaires, a blood sample, and repeat pH testing were completed.

Results: Sixty-nine patients were identified. Group A's depression score (8.6 +/- 4.1) was significantly higher than group B's (5.9 +/- 4.2; P = 0.03). Cytokine levels were similar in both groups. Forty-seven of 49 (96%) patients who underwent repeat pH testing had a negative study. Symptom-reflux correlation was highly significant (P < 0.001).

Conclusion: Some patients with recurrent heartburn and a negative pH study have associated functional or psychiatric comorbidities such as depression. Reproducibility of 24-h pH testing in these patients is excellent.

Publication types

  • Comparative Study

MeSH terms

  • Esophageal pH Monitoring
  • Female
  • Follow-Up Studies
  • Fundoplication / methods*
  • Gastroesophageal Reflux / metabolism
  • Gastroesophageal Reflux / surgery*
  • Heartburn / metabolism
  • Heartburn / surgery*
  • Humans
  • Hydrogen-Ion Concentration
  • Laparoscopy
  • Male
  • Middle Aged
  • Postoperative Period
  • Prognosis
  • Prospective Studies
  • Recurrence
  • Risk Factors