Psychological intervention influences the outcome of laparoscopic antireflux surgery in patients with stress-related symptoms of gastroesophageal reflux disease

Background: Psychological aspects such as stress, emotions, illness behavio ur or personality are known to affect the severity of symptoms of gastroeso phageal reflux disease (GERD) and can influence medical outcome in some pat ients. The aim of the present study was to evaluate the efficacy of psychol ogical intervention within routine surgical care on the surgical outcome of laparoscopic antireflux surgery (LARS) in patients with stress-ralated GER D symptoms during a I-year follow-up. Methods: Out of a sample of 196 conse cutive patients who required LAPS (Nissen fundoplication), a group of 89 (4 5%) believed that stress was a factor in the cause of their symptoms (stres s-related versus stress-unrelated GERD patients). Patients with stress-rela ted symptoms were randomly assigned to the psychological intervention (PI g roup; n =32) or control group with routine surgical care (RC group; n=42). Five patients were excluded from the study. Assessments of surgical outcome were: objective clinical data such as DeMeester score or lower oesophageal sphincter pressure, Gastrointestinal Quality-of-Life index (GIQLI), evalua tion of potential side effects such as subjective degree of dysphagia, gene ral impairment as a result of LAPS, and patient satisfaction with surgery. Results: There were no significant differences in objective clinical data b etween the different treatment groups before and after surgery. Before surg ery, patients with stress-related symptoms had a lower GIQLI and an increas ed spectrum of gastrointestinal (GI) symptoms compared with patients withou t stress-related symptoms. A significant impact (P < 0.05-0.01) of psycholo gical intervention on quality-of-life data, especially in GI symptoms, degr ee of dysphagia and general impairment, could be calculated after surgery. No differences in satisfaction with therapy were detectable. Comparing outc ome, no significant differences between patients without stress-related GER D symptoms: and the PI group were found. Generally, quality-of-life data in all patients improved significantly and patient satisfaction was excellent or good in 98.9% one year after surgery. In two patients a laparoscopic re fundoplication was neccessary because of a 'slipping Nissen'. Conclusions: These findings indicate that there is no impact of psychological interventi on on objective clinical data. Patients with stress-related GERD symptoms p rofit significantly from psychological intervention in patient-related fact ors of surgical outcome such as quality of life or degree of several aspect s such as dysphagia and general impairment. Generally, LARS in patients wit h stress-related GERD symptoms is an effective and safe procedure which imp roves quality of life with fewer side effects. Psychological intervention r educes non GERD-related GI symptoms and makes the outcome comparable to the outcome of patients without stress-related symptoms. We therefore suggest that surgical treatment alone in patients with stress-related GERD symptoms is incomplete and that psychological intervention can optimize surgical ou tcome in these patients.