Acid exposure time better predicts outcomes following anti-reflux surgery than DeMeester score
Background Criteria to diagnose gastroesophageal reflux disease (GERD) vary. The American Gastroenterology Association (AGA) 2022 Expert Review on GERD focuses on acid exposure time (AET) rather than DeMeester score from ambulatory pH testing (BRAVO). We aim to review outcomes following anti-reflux...
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| Veröffentlicht in: | Surgical endoscopy 2023-08, Vol.37 (8), p.6577-6587 |
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| creator | Amundson, Julia R. Zukancic, Haris Kuchta, Kristine Zimmermann, Christopher J. VanDruff, Vanessa N. Joseph, Stephanie Che, Simon Ishii, Shun Hedberg, H. Mason Ujiki, Michael B. |
| description | Background
Criteria to diagnose gastroesophageal reflux disease (GERD) vary. The American Gastroenterology Association (AGA) 2022 Expert Review on GERD focuses on acid exposure time (AET) rather than DeMeester score from ambulatory pH testing (BRAVO). We aim to review outcomes following anti-reflux surgery (ARS) at our institution, grouped by differing criteria for the diagnosis of GERD.
Methods
A retrospective review of a prospective gastroesophageal quality database was performed for all patients undergoing evaluation for ARS with preoperative BRAVO ≥ 48 h. Group comparisons were made using two-tailed Wilcoxon rank-sum and Fisher’s exact tests and two-tailed statistical significance of
p
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| doi_str_mv | 10.1007/s00464-023-10164-0 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2825809750</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2825809750</sourcerecordid><originalsourceid>FETCH-LOGICAL-c326t-aa6178099d85ec8712639d4110a8fa4a23997f561ab1c1499ebc1bbec6fb3cd03</originalsourceid><addsrcrecordid>eNp9kMtOxCAUhonR6Hh5AReGxI2bKgd6gaXxnmjc6FZC6elY05YR2qhvL3VGTVy4goTv_PznI2Qf2DEwVpwExtI8TRgXCTCYbmtkBqngCecg18mMKcESXqh0i2yH8MIiryDbJFuiEABSyhl5OrVNRfF94cLokQ5Nh7TEYUBPFx6rxg6BunGwrsNAa9e27q3p59T0Q5N4rNvxncbBOfoPOjybnp7jHWKYxoN1HnfJRm3agHurc4c8Xl48nF0nt_dXN2ent4kVPB8SY3IoJFOqkhlaWQDPhapSAGZkbVLDhVJFneVgSrCQKoWlhbJEm9elsBUTO-Rombvw7nWMBXTXBItta3p0Y9Bc8izmF9mEHv5BX9zo-9guUiKH2EIWkeJLynoXQtxUL3zTGf-hgenJvl7a19G-_rKvp-iDVfRYdlj9jHzrjoBYAiE-9dHa79__xH4CPxGQNw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2836109987</pqid></control><display><type>article</type><title>Acid exposure time better predicts outcomes following anti-reflux surgery than DeMeester score</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Amundson, Julia R. ; Zukancic, Haris ; Kuchta, Kristine ; Zimmermann, Christopher J. ; VanDruff, Vanessa N. ; Joseph, Stephanie ; Che, Simon ; Ishii, Shun ; Hedberg, H. Mason ; Ujiki, Michael B.</creator><creatorcontrib>Amundson, Julia R. ; Zukancic, Haris ; Kuchta, Kristine ; Zimmermann, Christopher J. ; VanDruff, Vanessa N. ; Joseph, Stephanie ; Che, Simon ; Ishii, Shun ; Hedberg, H. Mason ; Ujiki, Michael B.</creatorcontrib><description>Background
Criteria to diagnose gastroesophageal reflux disease (GERD) vary. The American Gastroenterology Association (AGA) 2022 Expert Review on GERD focuses on acid exposure time (AET) rather than DeMeester score from ambulatory pH testing (BRAVO). We aim to review outcomes following anti-reflux surgery (ARS) at our institution, grouped by differing criteria for the diagnosis of GERD.
Methods
A retrospective review of a prospective gastroesophageal quality database was performed for all patients undergoing evaluation for ARS with preoperative BRAVO ≥ 48 h. Group comparisons were made using two-tailed Wilcoxon rank-sum and Fisher’s exact tests and two-tailed statistical significance of
p
< 0.05.
Results
Between 2010 and 2022, 253 patients underwent an evaluation for ARS with BRAVO testing. Most patients (86.9%) met our institution’s historical criteria: LA C/D esophagitis, Barrett’s, or DeMeester ≥ 14.72 on 1+ days. Fewer patients (67.2%) met new AGA criteria: LA B/C/D esophagitis, Barrett’s, or AET ≥ 6% on 2+ days. Sixty-one patients (24%) met historical criteria only, with significantly lower BMI, ASA, less hiatal hernias, and less DeMeester and AET-positive days, a less severe GERD phenotype. There were no differences between groups in perioperative outcomes or % symptom resolution. Objective GERD outcomes (need for dilation, esophagitis, and postop BRAVO) were equivalent between groups. Patient-reported quality of life scores, including GERD-HRQL, RSI, and Dysphagia Score did not differ between groups from preop through 1 year postop. Those who met our historical criteria only reported significantly worse RSI scores (
p
= 0.03) and worse GERD-HRQL scores at 2 years postop, though not statistically significant (
p
= 0.07).
Conclusion
Updated AGA GERD guidelines exclude a portion of patients who historically would have been diagnosed with and surgically treated for GERD. This cohort appears to have a less severe GERD phenotype but equivalent outcomes up to 1 year, with more atypical GERD symptoms at 2 years postop. AET may better define who should be offered ARS than DeMeester score.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-023-10164-0</identifier><identifier>PMID: 37311888</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>2023 SAGES Oral ; Abdominal Surgery ; Acids ; Dysphagia ; Endoscopy ; Esophagitis ; Esophagus ; Gastroenterology ; Gastroesophageal reflux ; Gastroesophageal Reflux - diagnosis ; Gastroesophageal Reflux - surgery ; Gynecology ; Hepatology ; Hernias ; Humans ; Medicine ; Medicine & Public Health ; Motility ; Patients ; Proctology ; Prospective Studies ; Quality of Life ; Retrospective Studies ; Surgeons ; Surgery ; Treatment Outcome</subject><ispartof>Surgical endoscopy, 2023-08, Vol.37 (8), p.6577-6587</ispartof><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c326t-aa6178099d85ec8712639d4110a8fa4a23997f561ab1c1499ebc1bbec6fb3cd03</cites><orcidid>0000-0002-9179-0129</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-023-10164-0$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-023-10164-0$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27923,27924,41487,42556,51318</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37311888$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Amundson, Julia R.</creatorcontrib><creatorcontrib>Zukancic, Haris</creatorcontrib><creatorcontrib>Kuchta, Kristine</creatorcontrib><creatorcontrib>Zimmermann, Christopher J.</creatorcontrib><creatorcontrib>VanDruff, Vanessa N.</creatorcontrib><creatorcontrib>Joseph, Stephanie</creatorcontrib><creatorcontrib>Che, Simon</creatorcontrib><creatorcontrib>Ishii, Shun</creatorcontrib><creatorcontrib>Hedberg, H. Mason</creatorcontrib><creatorcontrib>Ujiki, Michael B.</creatorcontrib><title>Acid exposure time better predicts outcomes following anti-reflux surgery than DeMeester score</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Background
Criteria to diagnose gastroesophageal reflux disease (GERD) vary. The American Gastroenterology Association (AGA) 2022 Expert Review on GERD focuses on acid exposure time (AET) rather than DeMeester score from ambulatory pH testing (BRAVO). We aim to review outcomes following anti-reflux surgery (ARS) at our institution, grouped by differing criteria for the diagnosis of GERD.
Methods
A retrospective review of a prospective gastroesophageal quality database was performed for all patients undergoing evaluation for ARS with preoperative BRAVO ≥ 48 h. Group comparisons were made using two-tailed Wilcoxon rank-sum and Fisher’s exact tests and two-tailed statistical significance of
p
< 0.05.
Results
Between 2010 and 2022, 253 patients underwent an evaluation for ARS with BRAVO testing. Most patients (86.9%) met our institution’s historical criteria: LA C/D esophagitis, Barrett’s, or DeMeester ≥ 14.72 on 1+ days. Fewer patients (67.2%) met new AGA criteria: LA B/C/D esophagitis, Barrett’s, or AET ≥ 6% on 2+ days. Sixty-one patients (24%) met historical criteria only, with significantly lower BMI, ASA, less hiatal hernias, and less DeMeester and AET-positive days, a less severe GERD phenotype. There were no differences between groups in perioperative outcomes or % symptom resolution. Objective GERD outcomes (need for dilation, esophagitis, and postop BRAVO) were equivalent between groups. Patient-reported quality of life scores, including GERD-HRQL, RSI, and Dysphagia Score did not differ between groups from preop through 1 year postop. Those who met our historical criteria only reported significantly worse RSI scores (
p
= 0.03) and worse GERD-HRQL scores at 2 years postop, though not statistically significant (
p
= 0.07).
Conclusion
Updated AGA GERD guidelines exclude a portion of patients who historically would have been diagnosed with and surgically treated for GERD. This cohort appears to have a less severe GERD phenotype but equivalent outcomes up to 1 year, with more atypical GERD symptoms at 2 years postop. AET may better define who should be offered ARS than DeMeester score.</description><subject>2023 SAGES Oral</subject><subject>Abdominal Surgery</subject><subject>Acids</subject><subject>Dysphagia</subject><subject>Endoscopy</subject><subject>Esophagitis</subject><subject>Esophagus</subject><subject>Gastroenterology</subject><subject>Gastroesophageal reflux</subject><subject>Gastroesophageal Reflux - diagnosis</subject><subject>Gastroesophageal Reflux - surgery</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Hernias</subject><subject>Humans</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Motility</subject><subject>Patients</subject><subject>Proctology</subject><subject>Prospective Studies</subject><subject>Quality of Life</subject><subject>Retrospective Studies</subject><subject>Surgeons</subject><subject>Surgery</subject><subject>Treatment Outcome</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kMtOxCAUhonR6Hh5AReGxI2bKgd6gaXxnmjc6FZC6elY05YR2qhvL3VGTVy4goTv_PznI2Qf2DEwVpwExtI8TRgXCTCYbmtkBqngCecg18mMKcESXqh0i2yH8MIiryDbJFuiEABSyhl5OrVNRfF94cLokQ5Nh7TEYUBPFx6rxg6BunGwrsNAa9e27q3p59T0Q5N4rNvxncbBOfoPOjybnp7jHWKYxoN1HnfJRm3agHurc4c8Xl48nF0nt_dXN2ent4kVPB8SY3IoJFOqkhlaWQDPhapSAGZkbVLDhVJFneVgSrCQKoWlhbJEm9elsBUTO-Rombvw7nWMBXTXBItta3p0Y9Bc8izmF9mEHv5BX9zo-9guUiKH2EIWkeJLynoXQtxUL3zTGf-hgenJvl7a19G-_rKvp-iDVfRYdlj9jHzrjoBYAiE-9dHa79__xH4CPxGQNw</recordid><startdate>20230801</startdate><enddate>20230801</enddate><creator>Amundson, Julia R.</creator><creator>Zukancic, Haris</creator><creator>Kuchta, Kristine</creator><creator>Zimmermann, Christopher J.</creator><creator>VanDruff, Vanessa N.</creator><creator>Joseph, Stephanie</creator><creator>Che, Simon</creator><creator>Ishii, Shun</creator><creator>Hedberg, H. Mason</creator><creator>Ujiki, Michael B.</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-9179-0129</orcidid></search><sort><creationdate>20230801</creationdate><title>Acid exposure time better predicts outcomes following anti-reflux surgery than DeMeester score</title><author>Amundson, Julia R. ; Zukancic, Haris ; Kuchta, Kristine ; Zimmermann, Christopher J. ; VanDruff, Vanessa N. ; Joseph, Stephanie ; Che, Simon ; Ishii, Shun ; Hedberg, H. Mason ; Ujiki, Michael B.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c326t-aa6178099d85ec8712639d4110a8fa4a23997f561ab1c1499ebc1bbec6fb3cd03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>2023 SAGES Oral</topic><topic>Abdominal Surgery</topic><topic>Acids</topic><topic>Dysphagia</topic><topic>Endoscopy</topic><topic>Esophagitis</topic><topic>Esophagus</topic><topic>Gastroenterology</topic><topic>Gastroesophageal reflux</topic><topic>Gastroesophageal Reflux - diagnosis</topic><topic>Gastroesophageal Reflux - surgery</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Hernias</topic><topic>Humans</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Motility</topic><topic>Patients</topic><topic>Proctology</topic><topic>Prospective Studies</topic><topic>Quality of Life</topic><topic>Retrospective Studies</topic><topic>Surgeons</topic><topic>Surgery</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Amundson, Julia R.</creatorcontrib><creatorcontrib>Zukancic, Haris</creatorcontrib><creatorcontrib>Kuchta, Kristine</creatorcontrib><creatorcontrib>Zimmermann, Christopher J.</creatorcontrib><creatorcontrib>VanDruff, Vanessa N.</creatorcontrib><creatorcontrib>Joseph, Stephanie</creatorcontrib><creatorcontrib>Che, Simon</creatorcontrib><creatorcontrib>Ishii, Shun</creatorcontrib><creatorcontrib>Hedberg, H. Mason</creatorcontrib><creatorcontrib>Ujiki, Michael B.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Amundson, Julia R.</au><au>Zukancic, Haris</au><au>Kuchta, Kristine</au><au>Zimmermann, Christopher J.</au><au>VanDruff, Vanessa N.</au><au>Joseph, Stephanie</au><au>Che, Simon</au><au>Ishii, Shun</au><au>Hedberg, H. Mason</au><au>Ujiki, Michael B.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Acid exposure time better predicts outcomes following anti-reflux surgery than DeMeester score</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2023-08-01</date><risdate>2023</risdate><volume>37</volume><issue>8</issue><spage>6577</spage><epage>6587</epage><pages>6577-6587</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>Background
Criteria to diagnose gastroesophageal reflux disease (GERD) vary. The American Gastroenterology Association (AGA) 2022 Expert Review on GERD focuses on acid exposure time (AET) rather than DeMeester score from ambulatory pH testing (BRAVO). We aim to review outcomes following anti-reflux surgery (ARS) at our institution, grouped by differing criteria for the diagnosis of GERD.
Methods
A retrospective review of a prospective gastroesophageal quality database was performed for all patients undergoing evaluation for ARS with preoperative BRAVO ≥ 48 h. Group comparisons were made using two-tailed Wilcoxon rank-sum and Fisher’s exact tests and two-tailed statistical significance of
p
< 0.05.
Results
Between 2010 and 2022, 253 patients underwent an evaluation for ARS with BRAVO testing. Most patients (86.9%) met our institution’s historical criteria: LA C/D esophagitis, Barrett’s, or DeMeester ≥ 14.72 on 1+ days. Fewer patients (67.2%) met new AGA criteria: LA B/C/D esophagitis, Barrett’s, or AET ≥ 6% on 2+ days. Sixty-one patients (24%) met historical criteria only, with significantly lower BMI, ASA, less hiatal hernias, and less DeMeester and AET-positive days, a less severe GERD phenotype. There were no differences between groups in perioperative outcomes or % symptom resolution. Objective GERD outcomes (need for dilation, esophagitis, and postop BRAVO) were equivalent between groups. Patient-reported quality of life scores, including GERD-HRQL, RSI, and Dysphagia Score did not differ between groups from preop through 1 year postop. Those who met our historical criteria only reported significantly worse RSI scores (
p
= 0.03) and worse GERD-HRQL scores at 2 years postop, though not statistically significant (
p
= 0.07).
Conclusion
Updated AGA GERD guidelines exclude a portion of patients who historically would have been diagnosed with and surgically treated for GERD. This cohort appears to have a less severe GERD phenotype but equivalent outcomes up to 1 year, with more atypical GERD symptoms at 2 years postop. AET may better define who should be offered ARS than DeMeester score.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>37311888</pmid><doi>10.1007/s00464-023-10164-0</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-9179-0129</orcidid></addata></record> |
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| ispartof | Surgical endoscopy, 2023-08, Vol.37 (8), p.6577-6587 |
| issn | 0930-2794 1432-2218 |
| language | eng |
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| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | 2023 SAGES Oral Abdominal Surgery Acids Dysphagia Endoscopy Esophagitis Esophagus Gastroenterology Gastroesophageal reflux Gastroesophageal Reflux - diagnosis Gastroesophageal Reflux - surgery Gynecology Hepatology Hernias Humans Medicine Medicine & Public Health Motility Patients Proctology Prospective Studies Quality of Life Retrospective Studies Surgeons Surgery Treatment Outcome |
| title | Acid exposure time better predicts outcomes following anti-reflux surgery than DeMeester score |
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