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:
Corresponding author: Hans Friedrich Fuchs, MD, Assistant Professor, Department of General Surgery, University of Cologne, Kerpener Str. 62, Cologne 50937, Germany.
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
Research background

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.

Research motivation

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.

Research objectives

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.

Research methods

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.

Research results

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).

Research conclusions

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.

Research perspectives

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.