Nissen fundoplication vs proton pump inhibitors for laryngopharyngeal reflux based on pH-monitoring and symptom-scale

Table 1 Baseline demographics, clinical characteristics and proportions for laparoscopic Nissen fundoplication and proton pump inhibitor groups

Characteristic/parameter	LNF	PPI	P value
No.	31	39
Age (yr)	47.2 ± 10.7	51.3 ± 12.5	0.218
Sex			0.670
Male	14 (45.2)	19 (48.7)
Female	17 (54.8)	20 (51.3)
BMI (kg/m2)	23.9 ± 3.8	25.0 ± 3.1	0.285
RSI score	15.3 ± 3.5	14.2 ± 4.0	0.759
Presenting complaint
Regurgitation1	21 (67.7)	26 (66.7)	0.926
Heartburn1	23 (74.2)	28 (71.8)	0.826
Cough	18 (58.1)	21 (53.8)	0.729
Mucus	14 (45.1)	12 (30.7)	0.222
Globus	27 (87.1)	20 (51.3)	0.0032
Hoarseness	12 (38.7)	10 (25.6)	0.248
Throat pain	12 (38.7)	10 (25.6)	0.248
Throat clearing	10 (32.2)	9 (23.1)	0.398

¹Represents gastroesophageal reflux disease typical symptoms;

²Represent statistical significant P values (P < 0.05). Values are given as mean ± SD or n (%). LNF: Laparoscopic Nissen fundoplication; PPI: Proton pump inhibitor; BMI: Body mass index; RSI: Reflux symptom index.

Table 2 Characteristics on the oropharyngeal pH-monitoring, manometry and endoscopy between laparoscopic Nissen fundoplication and proton pump inhibitor groups

Characteristic/examination parameter	LNF	PPI	P value
Oropharyngeal pH-monitoring
Acid exposure (upright, %)	11.77 ± 18.95	8.49 ± 15.66	0.416
Acid exposure (supine, %)	4.25 ± 12.79	3.28 ± 7.92	0.182
Number of reflux events (upright)	53.84 ± 97.48	34.93 ± 65.35	0.195
Number of reflux events (supine)	7.44 ± 18.42	5.14 ± 9.22	0.232
Ryan score (upright)	335.13 ± 491.08	274.57 ± 459.10	0.617
Ryan score (supine)	8.98 ± 16.18	7.23 ± 7.81	0.217
High-resolution Manometry
LES pressure (mmHg)	11.78 ± 8.07	14.84 ± 9.73	0.236
UES pressure (mmHg)	43.8 ± 28.33	67.08 ± 42.51	0.0451
Dysperistalsis	3 (9.7)	10 (25.6)	0.0901
Hiatal hernia	24 (77.4)	33 (84.6)	0.449
GI endoscopy
Esophagitis (grade A)	10 (32.2)	10 (25.6)	0.549
Esophagitis (grade B)	3 (9.7)	2 (5.1)	0.470
Hiatal hernia	16 (51.6)	30 (76.9)	0.0271

¹Represent statistical significant P values (P < 0.05). Values are given as mean ± SD or n (%). LNF: Laparoscopic Nissen fundoplication; PPI: Proton pump inhibitor; LES: Lower esophageal sphincter; UES: Upper esophageal sphincter.

Table 3 Comparison of the laryngopharyngeal and gastroesophageal reflux disease typical symptom score between laparoscopic Nissen fundoplication and proton pump inhibitor groups before treatment and at 6-mo and 2-year follow-up

Characteristic/symptom score (No. of LNF/PPI)	Baseline (n = 70)			6-mo follow-up (n = 61)			2-yr follow-up (n = 53)
	LNF	PPI	P value	LNF	PPI	P value	LNF	PPI	P value
Regurgitation2 (17/20)	6.47 ± 0.62	6.24 ± 0.56	0.385	1.41 ± 1.69	2.53 ± 1.15	0.0221	1.12 ± 1.47	2.53 ± 1.26	0.0051
Heartburn2 (19/20)	6.33 ± 0.68	6.30 ± 0.59	0.100	1.33 ± 1.06	2.60 ± 1.69	0.0081	0.94 ± 1.10	3.05 ± 2.20	0.0011
Cough (15/16)	7.71 ± 0.82	7.67 ± 0.46	0.804	2.34 ± 2.37	4.40 ± 2.10	0.0221	2.28 ± 2.12	5.00 ± 2.28	0.0121
Mucus (11/9)	7.09 ± 0.83	7.22 ± 0.44	0.824	2.82 ± 2.24	4.77 ± 1.85	0.0551	3.27 ± 2.18	5.29 ± 1.78	0.0201
Globus (23/14)	6.10 ± 0.66	7.01 ± 0.88	0.268	2.95 ± 2.75	5.43 ± 2.50	0.0131	2.77 ± 2.87	5.28 ± 2.86	0.0171
Hoarseness (10/7)	7.30 ± 2.78	7.33 ± 2.55	0.954	3.80 ± 2.69	5.00 ± 2.65	0.409	3.50 ± 2.76	4.33 ± 2.53	0.546
Throat pain (11/4)	7.20 ± 1.03	7.50 ± 0.58	0.552	3.70 ± 2.98	5.50 ± 2.65	0.100	3.20 ± 3.46	4.25 ± 2.06	0.166
Throat clearing (6/7)	7.67 ± 0.52	7.14 ± 0.52	0.063	3.33 ± 2.06	6.00 ± 1.53	0.0341	2.83 ± 2.40	6.28 ± 1.51	0.0201

¹Represent statistical significant P values (P < 0.05);

²Represents gastroesophageal reflux disease typical symptoms. Values are given as mean ± SD. LNF: Laparoscopic Nissen fundoplication; PPI: Proton pump inhibitor.

Table 4 Comparison of outcome between laparoscopic Nissen fundoplication and proton pump inhibitor administration by 2-year follow-up

Characteristic/parameter	LNF (n = 25)	PPI (n = 28)	P value
BMI (kg/m2)
Pre-treatment	24.9 ± 3.8	25.0 ± 3.1	0.285
Post-treatment	22.2 ± 3.12	25.1 ± 2.9	0.0011
RSI score (value)
Pre-treatment	15.3 ± 3.5	14.2 ± 4.0	0.759
Post-treatment	9.7 ± 4.12	12.8 ± 3.12	0.0041
RSI score (≥ 13), n (%)
Pre-treatment	19 (76.0)	24 (85.7)	0.284
Post-treatment	7 (28.0)2	19 (67.9)2	0.0031
PPI independence, n (%)	11(44.0)	2 (7.14)	0.0001
Satisfaction, n (%)	62.49 ± 28.68	44.36 ± 32.77	0.0041

¹Represent statistical significant P values between LNF and PPI group;

²Represent statistical significant P values between pre-treatment and post-treatment for 2-year follow-up (P < 0.05). Values are given as mean ± SD or n (%). LNF: Laparoscopic Nissen fundoplication; PPI: Proton pump inhibitor.