Respiratory symptoms and dysphagia in patients with gastroesophageal reflux disease: a comparison of medical and surgical therapy

Background: Gastroesophageal reflux disease (GERD) is a common condition an d may frequently lead to dysphagia and respiratory symptoms. The aim of thi s study was to investigate the effects of medical and surgical therapy to c ontrol these symptoms. Methods: Eighty GERD patients with either dysphagia or respiratory symptoms were studied by means of a detailed symptom questio nnaire, upper gastrointestinal endoscopy, esophageal manometry, 24-h esopha geal pH monitoring and a barium esophagogram. All patients had been receivi ng medical therapy with proton-pump inhibitors and cisapride for 6 months. After withdrawal of medical therapy and relapse of GERD, 62 patients decide d to undergo anti-reflux surgery (laparoscopic Nissen fundoplication in 19 and laparoscopic partial posterior fundoplication in 43 patients). Symptoms were assessed prior to treatment, at 6 months following medical therapy an d 6 months after surgery. Results: Heartburn and esophagitis were effective ly treated by medical and surgical therapy. Dysphagia was improved in all p atients following surgery but only in 27% of patients following medical the rapy. Improvement of respiratory symptoms was found in 86% of patients foll owing surgery but only in 14% following medical therapy. Improvement of reg urgitation was registered only following surgical therapy. Conclusions: Sin ce medical treatment is likely to fail in GERD patients with complex sympto ms such as dysphagia, regurgitation and respiratory symptoms, the need for surgery arises in these patients and may be the only successful treatment i n the long term.