Response of atypical symptoms of gastro-oesophageal reflux to antireflux surgery

Background: Atypical manifestations of gastro-oesophageal reflux (GOR) incl ude asthma, chest pain, cough and hoarseness. The effectiveness of antirefl ux surgery for these symptoms is uncertain. The present study compared symp tomatic response rates for typical and atypical GOR symptoms after fundopli cation. Methods: Between October 1991 and January 1998, 324 patients underwent lapa roscopic fundoplication at Emory University Hospital and returned postopera tive questionnaires. Severity of typical (heartburn) and atypical (asthma, chest pain, cough and hoarseness) GOR symptoms was reported by patients on a 0-4 scale before surgery, and at 6 and 52 weeks after operation. Patients were stratified based on preoperative symptoms into three groups: group 1 (severe heartburn/minimal atypical symptoms), group 2 (severe heartburn/sev ere atypical symptoms) and group 3 (minimal heartburn/severe atypical sympt oms). Results: In group 1 (n = 173) heartburn improved in 99 per cent and resolve d in 87 per cent. In group 2 (n = 95) heartburn improved in 95 per cent and resolved in 76 per cent, and atypical symptoms unproved in 94 per cent and resolved in 42 per cent. In group 3 (n = 56) atypical symptoms improved in 93 per cent and resolved in 48 per cent. Although all symptoms were improv ed by fundoplication, resolution was more likely for heartburn than for aty pical symptoms. Conclusion: Atypical symptoms of GOR are improved by fundoplication, but sy mptom resolution occurs in fewer than 50 per cent of patients.