Response of Atypical Symptoms of GERD to Antireflux Surgery

Background/Aims: The results of laparoscopic Nissen's fundoplication (LNF) were compared in patients having typical and atypical symptoms of Gastroesophageal reflux disease (GERD). Atypical symptoms include asthma, chronic cough, non-cardiac chest pain, and ear, nose, and throat symptoms. The effectiveness of antireflux surgery in relief of these symptoms is uncertain. Methodology: 100 patients with GERD underwent laparoscopic Nissen's fundoplication in El-Mansoura Gastro-enterology center between January, 2002 and March, 2004. Patients were classified according to preoperative symptoms into 3 groups; group 1 (71 cases with severe typical and minimal atypical symptoms), group 2 (18 cases with severe typical and severe atypical symptoms) and group 3 (11 cases with minimal typical and severe atypical symptoms). Patients were reassessed within a mean period of 24 12 months after surgery. Results: Duration of illness was nearly similar in the three groups (3.2 +/- 2.7:3.3 +/- 2.9:3.7 +/- 3.2 years). In group 1, typical symptoms improved in 66(92.9%) cases and resolved in 63(88.7%). In group 2, typical symptoms improved in 17(94.4%) and resolved in 16(88.9%), whereas atypical symptoms improved in 15(83.3%) and resolved in 10(55.6%). In group 3, atypical symptoms improved in 9(81.8%) and resolved in 5(45.5%). Endoscopic, radiologic, esophageal motility and pH metry studies were nearly similar in the 3 groups. Conclusions: Antireflux surgery improves atypical symptoms of GERD, but symptom resolution occurs in less than half of cases.