OUTCOME OF RESPIRATORY SYMPTOMS AFTER ANTIREFLUX SURGERY ON PATIENTS WITH GASTROESOPHAGEAL REFLUX DISEASE

Objective: To investigate factors predictive of relief of respiratory symptoms associated with gastroesophageal reflux disease (GERD). Desig n: A case series of patients with GERD and respiratory symptoms underg oing fundoplication from 1987 to 1994 at a tertiary care university ho spital. Patients: Of 118 patients undergoing fundoplication for cardin al symptoms of GERD, 63 had respiratory symptoms. Postoperative follow -up information was available in 50 patients at a median of 3 years. I nterventions: The presence of GERD was documented on the basis of bari um swallow, esophagoscopy, esophageal manometry, and 24-hour pH studie s. A standardized questionnaire was used to score symptoms. A Nissen f undoplication was performed in 39 patients, a Collis-Belsey procedure in 8, and a Belsey fundoplication in 3 patients. Main Outcome Measures : A repeat standardized questionnaire was used to evaluate the respons e to surgery for each symptom experienced. Univariate analysis was per formed to evaluate factors influencing outcome. Results: Respiratory s ymptoms were present in 53% (63/118) of patients with GERD. Fundoplica tion relieved the respiratory symptoms in 76% (38/50) of the patients. Reflux symptoms were relieved in 86% (43/50) of the patients. Abnorma lities of esophageal motility were present in 34% (17/50) of the patie nts, and these were significantly more common in patients who did not experience relief of their respiratory symptoms (9/12 vs 8/38, chi(2) = 9.54, P = .002). Conclusions: Respiratory symptoms are common in pat ients with GERD. Unlike classic reflux symptoms, the beneficial effect s of antireflux surgery on respiratory symptoms are less predictable. The probability of relief of these respiratory symptoms with antireflu x surgery is directly dependent on esophageal motor function.