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RECURRENT HEARTBURN AFTER FUNDOPLICATION WITH A NEGATIVE 24‐HR PH ASSESSMENT: RECURRENT REFLUX OR “IRRITABLE OESOPHAGUS”?
Author(s) -
Thompson S. K.,
Jamieson G. G.,
Myers J. C.,
Parr Z.,
Devitt P. G.
Publication year - 2007
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2007.04122_29.x
Subject(s) - medicine , heartburn , reflux , asymptomatic , gastroenterology , cohort , prospective cohort study , irritable bowel syndrome , disease
Purpose A small cohort of patients present after antireflux surgery complaining of recurrent heartburn. Over two thirds will have a negative 24‐hr pH study. Our objective is to determine whether these patients have a functional disorder. We are therefore first confirming that there is no recurrent reflux and then investigating whether they have altered cytokine levels and symptomatic relief from an herbal medicine, Iberogast ®. Patient recruitment is ongoing and this report documents the reproducibility of 24‐hr pH testing in this group of patients. Methodology A prospective analysis has been carried out on a cohort of patients (identified from the Royal Adelaide Hospital Oesophageal Function database) who have undergone a fundoplication and pH testing for recurrent heartburn. Group A: patients with recurrent heartburn and a negative 24‐hr pH study. Group B (control group): patients with recurrent heartburn and a positive pH study (treated with medication/surgery; asymptomatic). As part of the study, Group A patients were asked to complete a 2nd post‐operative 24‐hr pH test. Results 159 patients were identified from our database, and 138 patients met our inclusion criteria. 91/138 (66%) patients have agreed to participate. 36/38 Group A patients (95%), who have thus far completed a repeat 24‐hr pH study, had a negative result. Symptom‐reflux correlation was highly significant (P < 0.001). Conclusions Reproducibility of 24‐hr pH testing in patients with recurrent heartburn and a negative 24‐hr pH study is excellent (95%) and seems better than the 70–80%, which is the usually quoted figure for this test. Therefore, a 2nd pH test to confirm initial results will be unnecessary in most patients.