Published online Jan 21, 2019. doi: 10.3748/wjg.v25.i3.388
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
Gastroesophageal reflux disease (GERD) shows a large symptom variation also in different intensities among patients. Up-to-date, patients with somatoform tendencies were often per se excluded from surgery.
There is a large overlap in the symptomatic spectrum between GERD and other disorders such as dyspepsia, functional heartburn or somatoform disorders. We intended to be able to better differentiate between these different entities to provide optimal patient care. Before our study, it was still unclear if patients with somatoform tendencies should undergo surgery at all.
The purpose of this study is an evaluation of patients with GERD with and without somatoform disorders before and after laparoscopic antireflux surgery regarding their outcome.
In the largest center for benign foregut surgery in Germany patients with GERD, qualifying for antireflux surgery were investigated prospectively regarding their symptomatic spectrum in order to identify GERD and associated somatoform disorders over a period of 3 years using an instrument for the evaluation of somatoform disorders. Quality of life was evaluated by Gastrointestinal Quality of Life Index (GIQLI). These parameters were compared depending on the group assignment of patients.
One fifth of all included patients suffered from somatoform tendencies (20.48%; 34 patients). Patients with this tendency had a preoperative GIQLI of 77 (32-111). Patients without this tendency had a GIQLI of 105 (29-140; P < 0.0001). 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. GIQLI of patients with GERD and somatoform tendency was improved from preoperative GIQLI 75 (47-111) to postoperative 95 (44-122; P < 0.0043).
This is the first study to show that patients with a somatoform tendency should not be excluded from surgery, however they will not reach a normal level of quality of life. Patients with GERD and somatoform disorders have an impaired quality of life. The latter patients can also benefit from laparoscopic fundoplication, however they will not reach a normal level.
The investigated instruments for assessment of quality of life and somatoform disorders can help to discriminate between the different symptom origins and should be used in all patients who undergo antireflux surgery.