Impact of symptom-reflux association analysis on long-term outcome after Nissen fundoplication

Br J Surg. 2011 Feb;98(2):247-54. doi: 10.1002/bjs.7296.


Background: A positive symptom association probability (SAP) is regarded as an important selection criterion for antireflux surgery by many physicians. However, no data corroborate the relationship between symptom-reflux association and outcome, nor is it clear what impact a negative SAP has on the outcome of antireflux surgery in patients with abnormal oesophageal acid exposure. This study compared long-term outcomes of Nissen fundoplication in patients with a negative versus positive SAP.

Methods: Five-year outcome of Nissen fundoplication in patients with proton-pump inhibitor (PPI)-refractory reflux and pathological acid exposure was compared between those with (SAP+, 109) and without (SAP-, 29 patients) a positive symptom association. Symptoms, quality of life (QoL), PPI use, endoscopic findings, manometry and acid exposure were evaluated.

Results: At 5 years' follow-up, relief of reflux symptoms (95 versus 87 per cent), reduction in PPI use (80 to 25 per cent versus 85 to 14 per cent; P < 0·050) and improvement in QoL were similar in the SAP- and SAP+ groups. Reduction in acid exposure time (13·4 to 1·6 per cent versus 11·1 to 0·2 per cent of total time; P < 0·010), improvement in oesophagitis (44 to 6 per cent versus 61 to 13 per cent; P < 0·050) and increase in lower oesophageal sphincter pressure were also comparable.

Conclusion: The subjective and objective outcomes of fundoplication in patients with pathological acid exposure are comparable among those with a positive and negative SAP. Patients with pathological acid exposure and a negative SAP can also benefit from antireflux surgery.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Fundoplication / methods*
  • Gastric Acid / physiology
  • Gastric Acidity Determination
  • Gastroesophageal Reflux / drug therapy
  • Gastroesophageal Reflux / surgery*
  • Humans
  • Hydrogen-Ion Concentration
  • Male
  • Middle Aged
  • Postoperative Complications / etiology
  • Prospective Studies
  • Proton Pump Inhibitors / therapeutic use
  • Randomized Controlled Trials as Topic
  • Treatment Outcome
  • Young Adult


  • Proton Pump Inhibitors