Effects of anti-reflux surgery on weakly acidic reflux and belching
BackgroundLaparoscopic Nissen fundoplication (LNF) is the most frequently performed operation for gastro-oesophageal reflux disease (GORD). However, 12% of the patients have persistent reflux symptoms and 19% develop gas-related symptoms after LNF. Weakly acidic reflux and inability to belch have be...
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| Veröffentlicht in: | Gut 2011-04, Vol.60 (4), p.435-441 |
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| description | BackgroundLaparoscopic Nissen fundoplication (LNF) is the most frequently performed operation for gastro-oesophageal reflux disease (GORD). However, 12% of the patients have persistent reflux symptoms and 19% develop gas-related symptoms after LNF. Weakly acidic reflux and inability to belch have been alleged to cause these symptoms, respectively. The effect of LNF on weakly acidic reflux and (supra) gastric belching was evaluated.MethodsIn 31 patients upper gastrointestinal endoscopy, stationary oesophageal manometry and 24-h impedance–pH monitoring off acid secretion inhibiting drugs was performed before and 6 months after primary LNF for GORD that was refractory to proton pump inhibitors. Patients filled out validated questionnaires on GERD-HRQoL before and 3, 6 and 12 months after surgery.ResultsLNF reduced reflux symptoms (18.6→1.6; p=0.015). The procedure drastically reduced the incidence (number per 24 h) of acid (76.0→1.6; p |
| doi_str_mv | 10.1136/gut.2010.224824 |
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| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_855911388</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1753459448</sourcerecordid><originalsourceid>FETCH-LOGICAL-b526t-6b37c3cdcea8a6f44688bd9c6d571b80b9f2bfbcf1707a357c7b8334ec7720bb3</originalsourceid><addsrcrecordid>eNqF0c9LHDEUB_AgFt2qZ29lQKRSGM3vlzmWxWrB6kW9hiSTbGednbHJDLr_fbPM1oKH9hRCPnm8974IHRN8TgiTF4txOKc43yjlivIdNCNcqpJRpXbRDGMCpQBe7aOPKS0xxkpVZA_tU0IqxgWdofllCN4NqehDYbqhKaMP7fhapDEufFwXfVe8ePPUrgvjmrpxxfbddHVhfet-Nt3iEH0Ipk3-aHseoIdvl_fz6_Lm7ur7_OtNaQWVQyktA8dc7bxRRgaeG1W2rpysBRCrsK0CtcG6QACDYQIcWMUY9w6AYmvZAfo81X2O_a_Rp0GvmuR825rO92PSSogqb0WpLM_-KQmIPH7F-YaevKPLfoxdniMrqBhQLkVWF5NysU8p70A_x2Zl4loTrDdJ6JyE3iShpyTyj0_buqNd-frN_1l9BqdbYJIzbYimc03661hujzCWXTm5Jg3-9e3dxCctgYHQt49z_QOTa5C3TEP2XyZvV8v_dvkbC5-rjQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1779372465</pqid></control><display><type>article</type><title>Effects of anti-reflux surgery on weakly acidic reflux and belching</title><source>MEDLINE</source><source>BMJ Journals - NESLi2</source><source>PubMed Central</source><creator>Broeders, J A J L ; Bredenoord, A J ; Hazebroek, E J ; Broeders, I A M J ; Gooszen, H G ; Smout, A J P M</creator><creatorcontrib>Broeders, J A J L ; Bredenoord, A J ; Hazebroek, E J ; Broeders, I A M J ; Gooszen, H G ; Smout, A J P M</creatorcontrib><description>BackgroundLaparoscopic Nissen fundoplication (LNF) is the most frequently performed operation for gastro-oesophageal reflux disease (GORD). However, 12% of the patients have persistent reflux symptoms and 19% develop gas-related symptoms after LNF. Weakly acidic reflux and inability to belch have been alleged to cause these symptoms, respectively. The effect of LNF on weakly acidic reflux and (supra) gastric belching was evaluated.MethodsIn 31 patients upper gastrointestinal endoscopy, stationary oesophageal manometry and 24-h impedance–pH monitoring off acid secretion inhibiting drugs was performed before and 6 months after primary LNF for GORD that was refractory to proton pump inhibitors. Patients filled out validated questionnaires on GERD-HRQoL before and 3, 6 and 12 months after surgery.ResultsLNF reduced reflux symptoms (18.6→1.6; p=0.015). The procedure drastically reduced the incidence (number per 24 h) of acid (76.0→1.6; p<0.001) and weakly acidic (13.6→5.7; p=0.001) as well as liquid (53.4→5.4; p<0.001) and mixed reflux episodes (36.3→1.9; p<0.001). In contrast, gas reflux was reduced to lesser extent (35.6→25.7; p=0.022). Proximal, mid-oesophageal and distal reflux were reduced to a similar extent. Persistent GORD symptoms were neither preceded by acid nor by weakly acidic reflux. The number of air swallows did not change, but the number of gastric belches (GBs) was greatly reduced (68.5→23.9; p<0.001). Twenty-three patients had supragastric belches (SGBs), both before and after surgery, whereas eight patients had no SGBs at all. The majority of SGBs were not reflux associated and the frequency was greatly increased after LNF (20.8→46.0; p=0.036). Reflux-associated SGBs were abolished after surgery (14.0→0.4; p<0.001).ConclusionsLNF similarly controls acid and weakly acidic reflux, but gas reflux is reduced to lesser extent. Persistent reflux symptoms are neither caused by acid nor by weakly acidic reflux. LNF alters the belching pattern by reducing GBs (air venting from stomach) and increasing SGBs (no air venting from stomach). This explains the increase in belching experienced by some patients after LNF, despite the reduction in gastric belching. It can be hypothesised that the reduction in GBs after LNF incites patients to increase SGBs in a futile attempt to vent air from the stomach.</description><identifier>ISSN: 0017-5749</identifier><identifier>EISSN: 1468-3288</identifier><identifier>DOI: 10.1136/gut.2010.224824</identifier><identifier>PMID: 21193452</identifier><identifier>CODEN: GUTTAK</identifier><language>eng</language><publisher>London: BMJ Publishing Group Ltd and British Society of Gastroenterology</publisher><subject>Acids ; Adult ; Aged ; anti-reflux surgery ; belching ; Biological and medical sciences ; Endoscopy, Gastrointestinal ; Eructation - surgery ; Esophageal pH Monitoring ; Esophagitis - etiology ; Female ; Fundoplication - methods ; Gastro-oesophageal reflux disease ; Gastroenterology. Liver. Pancreas. Abdomen ; Gastroesophageal Reflux - complications ; Gastroesophageal Reflux - surgery ; Humans ; impedance-pH monitoring ; Laparoscopy ; Laparoscopy - methods ; Male ; Manometry ; Medical sciences ; Middle Aged ; oesophageal pH monitoring ; oesophageal physiology ; oesophageal reflux ; Physiology ; Prospective Studies ; Stomach ; Studies ; Surgery ; Treatment Outcome ; weakly acidic reflux</subject><ispartof>Gut, 2011-04, Vol.60 (4), p.435-441</ispartof><rights>2011, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.</rights><rights>2015 INIST-CNRS</rights><rights>Copyright: 2011 (c) 2011, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b526t-6b37c3cdcea8a6f44688bd9c6d571b80b9f2bfbcf1707a357c7b8334ec7720bb3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttp://gut.bmj.com/content/60/4/435.full.pdf$$EPDF$$P50$$Gbmj$$H</linktopdf><linktohtml>$$Uhttp://gut.bmj.com/content/60/4/435.full$$EHTML$$P50$$Gbmj$$H</linktohtml><link.rule.ids>114,115,314,776,780,3183,23550,27901,27902,77343,77374</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=23944133$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21193452$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Broeders, J A J L</creatorcontrib><creatorcontrib>Bredenoord, A J</creatorcontrib><creatorcontrib>Hazebroek, E J</creatorcontrib><creatorcontrib>Broeders, I A M J</creatorcontrib><creatorcontrib>Gooszen, H G</creatorcontrib><creatorcontrib>Smout, A J P M</creatorcontrib><title>Effects of anti-reflux surgery on weakly acidic reflux and belching</title><title>Gut</title><addtitle>Gut</addtitle><description>BackgroundLaparoscopic Nissen fundoplication (LNF) is the most frequently performed operation for gastro-oesophageal reflux disease (GORD). However, 12% of the patients have persistent reflux symptoms and 19% develop gas-related symptoms after LNF. Weakly acidic reflux and inability to belch have been alleged to cause these symptoms, respectively. The effect of LNF on weakly acidic reflux and (supra) gastric belching was evaluated.MethodsIn 31 patients upper gastrointestinal endoscopy, stationary oesophageal manometry and 24-h impedance–pH monitoring off acid secretion inhibiting drugs was performed before and 6 months after primary LNF for GORD that was refractory to proton pump inhibitors. Patients filled out validated questionnaires on GERD-HRQoL before and 3, 6 and 12 months after surgery.ResultsLNF reduced reflux symptoms (18.6→1.6; p=0.015). The procedure drastically reduced the incidence (number per 24 h) of acid (76.0→1.6; p<0.001) and weakly acidic (13.6→5.7; p=0.001) as well as liquid (53.4→5.4; p<0.001) and mixed reflux episodes (36.3→1.9; p<0.001). In contrast, gas reflux was reduced to lesser extent (35.6→25.7; p=0.022). Proximal, mid-oesophageal and distal reflux were reduced to a similar extent. Persistent GORD symptoms were neither preceded by acid nor by weakly acidic reflux. The number of air swallows did not change, but the number of gastric belches (GBs) was greatly reduced (68.5→23.9; p<0.001). Twenty-three patients had supragastric belches (SGBs), both before and after surgery, whereas eight patients had no SGBs at all. The majority of SGBs were not reflux associated and the frequency was greatly increased after LNF (20.8→46.0; p=0.036). Reflux-associated SGBs were abolished after surgery (14.0→0.4; p<0.001).ConclusionsLNF similarly controls acid and weakly acidic reflux, but gas reflux is reduced to lesser extent. Persistent reflux symptoms are neither caused by acid nor by weakly acidic reflux. LNF alters the belching pattern by reducing GBs (air venting from stomach) and increasing SGBs (no air venting from stomach). This explains the increase in belching experienced by some patients after LNF, despite the reduction in gastric belching. It can be hypothesised that the reduction in GBs after LNF incites patients to increase SGBs in a futile attempt to vent air from the stomach.</description><subject>Acids</subject><subject>Adult</subject><subject>Aged</subject><subject>anti-reflux surgery</subject><subject>belching</subject><subject>Biological and medical sciences</subject><subject>Endoscopy, Gastrointestinal</subject><subject>Eructation - surgery</subject><subject>Esophageal pH Monitoring</subject><subject>Esophagitis - etiology</subject><subject>Female</subject><subject>Fundoplication - methods</subject><subject>Gastro-oesophageal reflux disease</subject><subject>Gastroenterology. Liver. Pancreas. Abdomen</subject><subject>Gastroesophageal Reflux - complications</subject><subject>Gastroesophageal Reflux - surgery</subject><subject>Humans</subject><subject>impedance-pH monitoring</subject><subject>Laparoscopy</subject><subject>Laparoscopy - methods</subject><subject>Male</subject><subject>Manometry</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>oesophageal pH monitoring</subject><subject>oesophageal physiology</subject><subject>oesophageal reflux</subject><subject>Physiology</subject><subject>Prospective Studies</subject><subject>Stomach</subject><subject>Studies</subject><subject>Surgery</subject><subject>Treatment Outcome</subject><subject>weakly acidic reflux</subject><issn>0017-5749</issn><issn>1468-3288</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqF0c9LHDEUB_AgFt2qZ29lQKRSGM3vlzmWxWrB6kW9hiSTbGednbHJDLr_fbPM1oKH9hRCPnm8974IHRN8TgiTF4txOKc43yjlivIdNCNcqpJRpXbRDGMCpQBe7aOPKS0xxkpVZA_tU0IqxgWdofllCN4NqehDYbqhKaMP7fhapDEufFwXfVe8ePPUrgvjmrpxxfbddHVhfet-Nt3iEH0Ipk3-aHseoIdvl_fz6_Lm7ur7_OtNaQWVQyktA8dc7bxRRgaeG1W2rpysBRCrsK0CtcG6QACDYQIcWMUY9w6AYmvZAfo81X2O_a_Rp0GvmuR825rO92PSSogqb0WpLM_-KQmIPH7F-YaevKPLfoxdniMrqBhQLkVWF5NysU8p70A_x2Zl4loTrDdJ6JyE3iShpyTyj0_buqNd-frN_1l9BqdbYJIzbYimc03661hujzCWXTm5Jg3-9e3dxCctgYHQt49z_QOTa5C3TEP2XyZvV8v_dvkbC5-rjQ</recordid><startdate>20110401</startdate><enddate>20110401</enddate><creator>Broeders, J A J L</creator><creator>Bredenoord, A J</creator><creator>Hazebroek, E J</creator><creator>Broeders, I A M J</creator><creator>Gooszen, H G</creator><creator>Smout, A J P M</creator><general>BMJ Publishing Group Ltd and British Society of Gastroenterology</general><general>BMJ Publishing Group</general><general>BMJ Publishing Group LTD</general><scope>BSCLL</scope><scope>IQODW</scope><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>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M2P</scope><scope>M7P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7T5</scope><scope>H94</scope><scope>7X8</scope></search><sort><creationdate>20110401</creationdate><title>Effects of anti-reflux surgery on weakly acidic reflux and belching</title><author>Broeders, J A J L ; Bredenoord, A J ; Hazebroek, E J ; Broeders, I A M J ; Gooszen, H G ; Smout, A J P M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b526t-6b37c3cdcea8a6f44688bd9c6d571b80b9f2bfbcf1707a357c7b8334ec7720bb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Acids</topic><topic>Adult</topic><topic>Aged</topic><topic>anti-reflux surgery</topic><topic>belching</topic><topic>Biological and medical sciences</topic><topic>Endoscopy, Gastrointestinal</topic><topic>Eructation - surgery</topic><topic>Esophageal pH Monitoring</topic><topic>Esophagitis - etiology</topic><topic>Female</topic><topic>Fundoplication - methods</topic><topic>Gastro-oesophageal reflux disease</topic><topic>Gastroenterology. Liver. Pancreas. Abdomen</topic><topic>Gastroesophageal Reflux - complications</topic><topic>Gastroesophageal Reflux - surgery</topic><topic>Humans</topic><topic>impedance-pH monitoring</topic><topic>Laparoscopy</topic><topic>Laparoscopy - methods</topic><topic>Male</topic><topic>Manometry</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>oesophageal pH monitoring</topic><topic>oesophageal physiology</topic><topic>oesophageal reflux</topic><topic>Physiology</topic><topic>Prospective Studies</topic><topic>Stomach</topic><topic>Studies</topic><topic>Surgery</topic><topic>Treatment Outcome</topic><topic>weakly acidic reflux</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Broeders, J A J L</creatorcontrib><creatorcontrib>Bredenoord, A J</creatorcontrib><creatorcontrib>Hazebroek, E J</creatorcontrib><creatorcontrib>Broeders, I A M J</creatorcontrib><creatorcontrib>Gooszen, H G</creatorcontrib><creatorcontrib>Smout, A J P M</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><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>ProQuest Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science 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)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest Natural Science Collection</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biological Sciences</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>ProQuest Science Journals</collection><collection>Biological Science Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Gut</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Broeders, J A J L</au><au>Bredenoord, A J</au><au>Hazebroek, E J</au><au>Broeders, I A M J</au><au>Gooszen, H G</au><au>Smout, A J P M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effects of anti-reflux surgery on weakly acidic reflux and belching</atitle><jtitle>Gut</jtitle><addtitle>Gut</addtitle><date>2011-04-01</date><risdate>2011</risdate><volume>60</volume><issue>4</issue><spage>435</spage><epage>441</epage><pages>435-441</pages><issn>0017-5749</issn><eissn>1468-3288</eissn><coden>GUTTAK</coden><abstract>BackgroundLaparoscopic Nissen fundoplication (LNF) is the most frequently performed operation for gastro-oesophageal reflux disease (GORD). However, 12% of the patients have persistent reflux symptoms and 19% develop gas-related symptoms after LNF. Weakly acidic reflux and inability to belch have been alleged to cause these symptoms, respectively. The effect of LNF on weakly acidic reflux and (supra) gastric belching was evaluated.MethodsIn 31 patients upper gastrointestinal endoscopy, stationary oesophageal manometry and 24-h impedance–pH monitoring off acid secretion inhibiting drugs was performed before and 6 months after primary LNF for GORD that was refractory to proton pump inhibitors. Patients filled out validated questionnaires on GERD-HRQoL before and 3, 6 and 12 months after surgery.ResultsLNF reduced reflux symptoms (18.6→1.6; p=0.015). The procedure drastically reduced the incidence (number per 24 h) of acid (76.0→1.6; p<0.001) and weakly acidic (13.6→5.7; p=0.001) as well as liquid (53.4→5.4; p<0.001) and mixed reflux episodes (36.3→1.9; p<0.001). In contrast, gas reflux was reduced to lesser extent (35.6→25.7; p=0.022). Proximal, mid-oesophageal and distal reflux were reduced to a similar extent. Persistent GORD symptoms were neither preceded by acid nor by weakly acidic reflux. The number of air swallows did not change, but the number of gastric belches (GBs) was greatly reduced (68.5→23.9; p<0.001). Twenty-three patients had supragastric belches (SGBs), both before and after surgery, whereas eight patients had no SGBs at all. The majority of SGBs were not reflux associated and the frequency was greatly increased after LNF (20.8→46.0; p=0.036). Reflux-associated SGBs were abolished after surgery (14.0→0.4; p<0.001).ConclusionsLNF similarly controls acid and weakly acidic reflux, but gas reflux is reduced to lesser extent. Persistent reflux symptoms are neither caused by acid nor by weakly acidic reflux. LNF alters the belching pattern by reducing GBs (air venting from stomach) and increasing SGBs (no air venting from stomach). This explains the increase in belching experienced by some patients after LNF, despite the reduction in gastric belching. It can be hypothesised that the reduction in GBs after LNF incites patients to increase SGBs in a futile attempt to vent air from the stomach.</abstract><cop>London</cop><pub>BMJ Publishing Group Ltd and British Society of Gastroenterology</pub><pmid>21193452</pmid><doi>10.1136/gut.2010.224824</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Acids Adult Aged anti-reflux surgery belching Biological and medical sciences Endoscopy, Gastrointestinal Eructation - surgery Esophageal pH Monitoring Esophagitis - etiology Female Fundoplication - methods Gastro-oesophageal reflux disease Gastroenterology. Liver. Pancreas. Abdomen Gastroesophageal Reflux - complications Gastroesophageal Reflux - surgery Humans impedance-pH monitoring Laparoscopy Laparoscopy - methods Male Manometry Medical sciences Middle Aged oesophageal pH monitoring oesophageal physiology oesophageal reflux Physiology Prospective Studies Stomach Studies Surgery Treatment Outcome weakly acidic reflux |
| title | Effects of anti-reflux surgery on weakly acidic reflux and belching |
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