Hessler Lindsay K, Xu Yiwei, Shada Amber L, Johnson Morgan K, Funk Luke M, Greenberg Jacob A, Lidor Anne O
Department of Surgery, Division of Minimally Invasive and Bariatric Surgery, School of Medicine and Public Health, University of Wisconsin, 600 Highland Avenue K4/752, Madison, WI, 53792-7375, USA.
William S. Middleton Memorial Veterans Hospital, Madison, WI, USA.
Surg Endosc. 2022 Jan;36(1):778-786. doi: 10.1007/s00464-020-08279-9. Epub 2021 Feb 2.
Laryngopharyngeal reflux (LPR) symptoms are often present in patients with Gastroesophageal reflux disease (GERD). Whereas antireflux surgery (ARS) provides predictably excellent results in patients with typical GERD, those with atypical symptoms have variable outcomes. The goal of this study was to characterize the response of LPR symptoms to antireflux surgery.
Patients who underwent ARS between January 2009 and May 2020 were prospectively identified from a single institutional database. Patient-reported information on LPR symptoms was collected at standardized time points (preoperative and 2 weeks, 8 weeks, and 1 year postoperatively) using a validated Reflux Symptom Index (RSI) questionnaire. Patients were grouped by preoperative RSI score: ≤ 13 (normal) and > 13 (abnormal). Baseline characteristics were compared between groups using chi-square test or t-test. A mixed effects model was used to evaluate improvement in RSI scores.
One hundred and seventy-six patients fulfilled inclusion criteria (mean age 57.8 years, 70% female, mean BMI 29.4). Patients with a preoperative RSI ≤ 13 (n = 61) and RSI > 13 (n = 115) were similar in age, BMI, primary reason for evaluation, DeMeester score, presence of esophagitis, and hiatal hernia (p > 0.05). The RSI > 13 group had more female patients (80 vs 52%, p = < 0.001), higher mean GERD-HRQL score, lower rates of PPI use, and normal esophageal motility. The RSI of all patients improved from a mean preoperative value of 19.2 to 7.8 (2 weeks), 6.1 (8 weeks), and 10.9 (1 year). Those with the highest preoperative scores (RSI > 30) had the best response to ARS. When analyzing individual symptoms, the most likely to improve included heartburn, hoarseness, and choking.
In our study population, patients with LPR symptoms achieved a rapid and durable response to antireflux surgery. Those with higher preoperative RSI scores experienced the greatest improvement. Our data suggest that antireflux surgery is a viable treatment option for this patient population.
喉咽反流（LPR）症状在胃食管反流病（GERD）患者中很常见。虽然抗反流手术（ARS）在典型GERD患者中能提供可预测的良好效果，但非典型症状患者的治疗结果却不尽相同。本研究的目的是描述LPR症状对抗反流手术的反应。
从单一机构数据库中前瞻性地识别出2009年1月至2020年5月期间接受ARS的患者。使用经过验证的反流症状指数（RSI）问卷，在标准化时间点（术前、术后2周、8周和1年）收集患者报告的LPR症状信息。患者按术前RSI评分分组：≤13（正常）和>13（异常）。使用卡方检验或t检验比较两组的基线特征。采用混合效应模型评估RSI评分的改善情况。
176例患者符合纳入标准（平均年龄57.8岁，70%为女性，平均BMI 29.4）。术前RSI≤13（n = 61）和RSI>13（n = 115）的患者在年龄、BMI、评估的主要原因、DeMeester评分、食管炎的存在和食管裂孔疝方面相似（p>0.05）。RSI > 13组女性患者更多（80%对52%，p = <0.001），GERD-HRQL平均评分更高，PPI使用率更低，食管动力正常。所有患者的RSI从术前平均19.2分改善到术后2周的7.8分、8周的6.1分和1年的10.9分。术前评分最高（RSI>30）的患者对ARS反应最佳。分析个体症状时，最可能改善的症状包括烧心、声音嘶哑和哽咽感。
在我们的研究人群中，有LPR症状的患者对抗反流手术有快速且持久的反应。术前RSI评分较高的患者改善最大。我们的数据表明，抗反流手术是这类患者可行的治疗选择。
