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      Pre-operative clinical and instrumental factors as antireflux surgery outcome predictors

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          Abstract

          Gastroesophageal reflux disease (GERD) is nowadays a highly prevalent, chronic condition, with 10% to 30% of Western populations affected by weekly symptoms. Many patients with mild reflux symptoms are treated adequately with lifestyle modifications, dietary changes, and low-dose proton pump inhibitors (PPIs). For those with refractory GERD poorly controlled with daily PPIs, numerous treatment options exist. Fundoplication is currently the most commonly performed antireflux operation for management of GERD. Outcomes described in current literature following laparoscopic fundoplication indicate that it is highly effective for treatment of GERD; early clinical studies demonstrate relief of symptoms in approximately 85%-90% of patients. However it is still unclear which factors, clinical or instrumental, are able to predict a good outcome after surgery. Virtually all demographic, esophagogastric junction anatomic conditions, as well as instrumental (such as presence of esophagitis at endoscopy, or motility patterns determined by esophageal high resolution manometry or reflux patterns determined by means of pH/impedance-pH monitoring) and clinical features (such as typical or atypical symptoms presence) of patients undergoing laparoscopic fundoplication for GERD can be factors associated with symptomatic relief. With this in mind, we sought to review studies that identified the factors that predict outcome after laparoscopic total fundoplication.

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          Most cited references83

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          Epidemiology of gastro-oesophageal reflux disease: a systematic review.

          A systematic review of the epidemiology of gastro-oesophageal reflux disease (GORD) has been performed, applying strict criteria for quality of studies and the disease definition used. The prevalence and incidence of GORD was estimated from 15 studies which defined GORD as at least weekly heartburn and/or acid regurgitation and met criteria concerning sample size, response rate, and recall period. Data on factors associated with GORD were also evaluated. An approximate prevalence of 10-20% was identified for GORD, defined by at least weekly heartburn and/or acid regurgitation in the Western world while in Asia this was lower, at less than 5%. The incidence in the Western world was approximately 5 per 1000 person years. A number of potential risk factors (for example, an immediate family history and obesity) and comorbidities (for example, respiratory diseases and chest pain) associated with GORD were identified. Data reported in this systematic review can be interpreted with confidence as reflecting the epidemiology of "true" GORD. The disease is more common in the Western world than in Asia, and the low rate of incidence relative to prevalence reflects its chronicity. The small number of studies eligible for inclusion in this review highlights the need for global consensus on a symptom based definition of GORD.
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            Esophageal pH-impedance monitoring and symptom analysis in GERD: a study in patients off and on therapy.

            Combined esophageal pH-impedance monitoring allows detection of nearly all gastroesophageal reflux episodes, acid as well as nonacid. However, the role of nonacid reflux in the pathogenesis of symptoms is poorly known. The aim of this study was to evaluate the diagnostic yield of this technique in patients with suspected reflux symptoms while on or off PPI therapy. The recordings of 150 patients recruited at seven academic centers with symptoms possibly related to gastroesophageal reflux were analyzed. Reflux events were detected visually using impedance (Sandhill, CO) and then characterized by pHmetry as acid or nonacid reflux. The temporal relationship between symptoms and reflux episodes was analyzed: a symptom association probability (SAP) > or =95% was considered indicative of a positive association. One hundred fifty patients were included, 102 women (mean age 52 +/- 14 yr, range 16-84). Among the 79 patients off PPI, five did not report any symptom during the recording period. A positive SAP was found in 41 of the 74 symptomatic patients (55.4%), including acid reflux in 23 (31.1%), nonacid reflux in three (4.1%), and acid and nonacid in 15 (20.3%). In the group of patients on PPI (N = 71, 46 women, mean age 51 +/- 15 yr), 11 were asymptomatic during the study, SAP was positive in 22 of the 60 symptomatic patients (36.7%), including acid reflux in three (5.0%), nonacid reflux in 10 (16.7%), and acid and nonacid in nine (15.0%). The symptoms most frequently associated with nonacid reflux were regurgitation and cough. Adding impedance to pH monitoring improves the diagnostic yield and allows better symptom analysis than pHmetry alone, mainly in patients on PPI therapy. The impact of this improved diagnostic value on gastroesophageal reflux disease management remains to be investigated by outcome studies.
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              Anxiety and depression in patients with gastroesophageal reflux disease and their effect on quality of life.

              To explore the role of psychological factors in gastroesophageal reflux disease (GERD) and their effect on quality of life (QoL) of GERD patients.
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                Author and article information

                Journal
                World J Gastrointest Surg
                WJGS
                World Journal of Gastrointestinal Surgery
                Baishideng Publishing Group Inc
                1948-9366
                27 November 2016
                27 November 2016
                : 8
                : 11
                : 719-728
                Affiliations
                Salvatore Tolone, Giorgia Gualtieri, Giuseppina Casalino, Simona Parisi, Ludovico Docimo, Division of General and Bariatric Surgery, Second University of Naples, 80131 Naples, Italy
                Edoardo Savarino, Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, 35121 Padua, Italy
                Marzio Frazzoni, Division of Gastroenterology, Baggiovara Hospital, 41121 Modena, Italy
                Nicola de Bortoli, Division of Gastroenterology, Department of Internal Medicine, University of Pisa, 56126 Pisa, Italy
                Manuele Furnari, Vincenzo Savarino, Division of Gastroenterology, Department of Internal Medicine, University of Genoa, 16123 Genoa, Italy
                Author notes

                Author contributions: Tolone S contributed to conception and design and drafting the article; Gualtieri G contributed to drafting the article; Savarino E, Frazzoni M, de Bortoli N, Furnari M, Casalino G and Parisi S contributed to acquisition and interpretation of data, and revisited it critically for important intellectual content; Savarino V and Docimo L gave final approval of the version to be published.

                Correspondence to: Salvatore Tolone, MD, PhD, Second University of Naples, Division of General and Bariatric Surgery, Via Pansini 5, 80131 Naples, Italy. salvatore.tolone@ 123456unina2.it

                Telephone: +39-81-5666658 Fax: +39-81-5666237

                Article
                jWJGS.v8.i11.pg719
                10.4240/wjgs.v8.i11.719
                5124700
                06a3512b-f226-4771-b75e-fdcb2f6eed47
                ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.

                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/

                History
                : 29 March 2016
                : 20 July 2016
                : 21 September 2016
                Categories
                Review

                gastroesophageal reflux disease,antireflux surgery,outcome predictors,fundoplication,nissen,laparoscopy,high resolution manometry,impedance-ph monitoring

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