Effect of laparoscopic fundoplication on gastroesophageal reflux disease -Induced respiratory symptoms

Laparoscopic fundoplication controls heartburn and regurgitation, but the e ffects on the respiratory symptoms of gastroesophageal reflux disease (GERD ) are unclear. Confusion stems from difficulty preoperatively in determinin g whether cough or wheezing is actually caused by reflux when reflux is fou nd on pH monitoring. To date, there is no proven way to pinpoint a cause-an d-effect relationship. The goals of this study were to assess the following : (1) the value of pH monitoring in establishing a correlation between resp irator?; symptoms and reflux; (2) the predictive value of pH monitoring on the results of surgical treatment; and (3) the outcome of laparoscopic fund oplication on GERD-induced respiratory symptoms. Between October 1992 and O ctober 1998, a total of 340 patients underwent laparoscopic fundoplication for GERD. From the clinical findings alone, respiratory symptoms were thoug ht possibly to be caused by GERD in 39 patients(11%). These 39 patients had been symptomatic for an average of 134 months. They were all taking H-2-bl ocking agents (21%) or proton pump inhibitors (79%). Seven patients (18%) w ere also being treated with bronchodilators, alone (3 patients) or in combi nation with prednisone (4 patients). Median length of postoperative follow- up was 28 months. In 23 patients (59%) a temporal correlation was found dur ing 24-hour pH monitoring between respiratory symptoms and episodes of refl ux. Postoperatively heartburn resolved in 91% of patients, regurgitation in 90% of patients, wheezing in 64% of patients, and cough in 74% of patients . Cough resolved in 19 (83%) of 23 patients in whom a correlation between c ough and reflux was found during pH monitoring, but in only 8 (57%) of 14 o f patients when this correlation was absent. Cough persisted postoperativel y in the two patients who did not cough during the study. These data show t hat pH monitoring helped to establish a correlation between respiratory: sy mptoms and reflux, and it helped to identify the patients most likely to be nefit from antireflux surgery. Following laparoscopic surgery, respiratory symptoms resolved in 83% of patients when a temporal correlation between co ugh and reflux was found on pH monitoring; heartburn and regurgitation reso lved in 90%.