Prospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 21, 2019; 25(3): 388-397
Published online Jan 21, 2019. doi: 10.3748/wjg.v25.i3.388
Do patients with gastroesophageal reflux disease and somatoform tendencies benefit from antireflux surgery?
Hans Friedrich Fuchs, Benjamin Babic, Karl-Hermann Fuchs, Wolfram Breithaupt, Gabor Varga, Frauke Musial
Hans Friedrich Fuchs, Department of General Surgery, University of Cologne, Cologne 50937, Germany
Benjamin Babic, Department of General Surgery, University of Mainz, Mainz D-55131, Germany
Karl-Hermann Fuchs, Department of Surgery, University of California San Diego, La Jolla, CA 92093, United States
Wolfram Breithaupt, Gabor Varga, Department of Surgery, Goethe University Frankfurt, Frankfurt am Main 60431, Germany
Frauke Musial, NAFKAM, Department of Community Medicine, UiT, The Arctic University of Norway, Tromsoe, N-9037, Norway
Author contributions: Fuchs HF, Fuchs KH, Musial F, Breithaupt W and Varga G had substantial contributions in the study concept and design, the revision and drafting of the manuscript, analysis and interpretation of the data and statistical analysis; Fuchs HF and Babic B had substantial contributions in the acquisition of the data, analysis and interpretation of data; all authors had substantial contribution in the drafting of the manuscript, revising of the manuscript and the final approval of the manuscript to be published; all authors agree to be accountable for all aspects of the work and ensuring its accuracy and its integrity.
Institutional review board statement: The study was reviewed and approved by the Markus Hospital Institutional Review Board.
Informed consent statement: All involved patients gave their informed consent prior to study inclusion.
Conflict-of-interest statement: The authors do not have any conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Hans Friedrich Fuchs, MD, Assistant Professor, Department of General Surgery, University of Cologne, Kerpener Str. 62, Cologne 50937, Germany. hans.fuchs@uk-koeln.de
Telephone: +49-221-4784803 Fax: +49-221-4784843
Received: November 9, 2018
Peer-review started: November 12, 2018
First decision: December 5, 2018
Revised: January 8, 2019
Accepted: January 14, 2019
Article in press: January 14, 2019
Published online: January 21, 2019
Processing time: 73 Days and 20.4 Hours
Abstract
BACKGROUND

The clinical presentation of gastroesophageal reflux disease (GERD) shows a large symptom variation also in different intensities among patients. As several studies have shown, there is a large overlap in the symptomatic spectrum between proven GERD and other disorders such as dyspepsia, functional heartburn and/or somatoform disorders.

AIM

To prospectively evaluate the GERD patients with and without somatoform disorders before and after laparoscopic antireflux surgery.

METHODS

In a tertiary referral center for foregut surgery over a period of 3 years patients with GERD, qualifying for the indication of laparoscopic antireflux surgery, were investigated prospectively regarding their symptomatic spectrum in order to identify GERD and associated somatoform disorders. Assessment of symptoms was performed by an instrument for the evaluation of somatoform disorders [Somatoform Symptom Index (SSI) > 17]. Quality of life was evaluated by Gastrointestinal Quality of Life Index (GIQLI).

RESULTS

In 123 patients an indication for laparoscopic antireflux surgery was established and in 43 patients further medical therapy was suggested. The portion of somatoform tendencies in the total patient population was 20.48% (34 patients). Patients with a positive SSI had a preoperative GIQLI of 77 (32-111). Patients with a normal SSI had a GIQLI of 105 (29-140) (P < 0.0001). In patients with GERD the quality of life could be normalized from preoperative reduced values of GIQLI 102 (47-140) to postoperative values of 117 (44-144). In patients with GERD and somatoform disorders, the GIQLI was improved from preoperative GIQLI 75 (47-111) to postoperative 95 (44-122) (P < 0.0043).

CONCLUSION

Patients with GERD and associated somatoform disorders have significantly worse levels of quality of life. The latter patients can also benefit from laparoscopic fundoplication, however they will not reach a normal level.

Keywords: Gastroesophageal reflux disease; Antireflux surgery; Laparoscopic fundoplication; Somatization; Gastroesophageal reflux disease symptoms

Core tip: The current level of evidence performing antireflux surgery in patients with overlapping symptoms such as dyspepsia, functional heartburn and/or somatoform disorders is limited and debated in small case series. In a tertiary referral center for foregut surgery (the largest center for antireflux surgery in Germany), we studied patients with gastroesophageal reflux disease (GERD) regarding their symptomatic spectrum over a period of 3 years. It was found that patients with GERD and associated somatoform disorders have significantly worse levels of quality of life. The latter patients can also benefit from laparoscopic fundoplication, however they will not reach a normal level.