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Am Fam Physician. 1999;59(11):3214

While gastroesophageal reflux disease (GERD) can usually be improved with medical therapy and lifestyle alterations, such lifestyle changes as dietary modification, sleeping with the head of the bed elevated and not eating late in the day may have a negative effect on the patient's quality of life. Trus and associates evaluated the effects of laparoscopic antireflux surgery on quality of life in patients with severe GERD.

Patients in the study underwent evaluation for possible surgery to correct GERD. The mean age of the 345 patients was 49 ± 14 years, and most of them underwent surgery for typical reflux symptoms, such as heartburn, regurgitation and dysphagia. The mean duration of GERD was eight years.

The generic (not disease-specific) medical outcome study questionnaire was used to evaluate quality-of-life measures. This 36-item form measures health concepts such as physical function, pain, general health perception, vitality, social function, mental health and well-being. A total of 289 patients completed a preoperative questionnaire, 223 completed a postoperative questionnaire, 181 completed both preoperative and postoperative questionnaires, and 50 completed the questionnaire one year after laparoscopic antireflux surgery.

The scores for each of eight quality-of-life measures showed significant improvement after antireflux surgery. The scores remained significantly improved for at least one year, indicating that surgery relieved reflux symptoms without negatively affecting quality of life.

The authors conclude that laparoscopic antireflux surgery is an effective treatment in patients with GERD. The findings suggest that it may be more effective than medical therapy in improving quality-of-life measures.

editor's note: Laparoscopic fundoplication has made it less invasive to operate on patients with GERD. Studies of laparoscopic antireflux surgery suggest that the typical symptoms of heartburn and regurgitation are relieved at a higher rate than the atypical symptoms associated with pulmonary, pharyngolaryngeal and epigastric syndromes. Good response to a pre-operative trial of omeprazole or histamine H2-receptor blockers was reported to be significantly associated with a better surgical outcome and greater relief of atypical symptoms. Manometric findings were not found to predict relief of atypical symptoms after surgery.—r.s.

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