Prospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 21, 2017; 23(19): 3546-3555
Published online May 21, 2017. doi: 10.3748/wjg.v23.i19.3546
Nissen fundoplication vs proton pump inhibitors for laryngopharyngeal reflux based on pH-monitoring and symptom-scale
Chao Zhang, Zhi-Wei Hu, Chao Yan, Qiong Wu, Ji-Min Wu, Xing Du, Dian-Gang Liu, Tao Luo, Fei Li, Zhong-Gao Wang
Chao Zhang, Chao Yan, Xing Du, Dian-Gang Liu, Tao Luo, Fei Li, Zhong-Gao Wang, Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
Zhi-Wei Hu, Ji-Min Wu, Zhong-Gao Wang, Department of Gastroesophageal Reflux Disease, Second Artillery General Hospital of Chinese People’s Liberation Army, Beijing 100088, China
Qiong Wu, Department of Nutrition, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
Author contributions: Zhang C and Hu ZW are co-first authors; Zhang C, Hu ZW, Yan C, Wu Q, Wu JM, Liu DG, Luo T, Li F, and Wang ZG designed and performed the research; Zhang C, Yan C, and Du X contributed the analytical tools; Zhang C and Hu ZW analyzed the data; Zhang C drafted the manuscript; Wang ZG revised the manuscript; and all authors read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the institutional review boards of Department of General Surgery, Xuanwu Hospital (Beijing, China), and Department of Gastroesophageal Reflux Disease, Second Artillery General Hospital of Chinese People’s Liberation Army (Beijing, China).
Informed consent statement: All study participants or their legal guardians provided written consent prior to study enrollment.
Conflict-of-interest statement: The authors of this manuscript having no conflicts of interest to disclose.
Data sharing statement: There are no additional data available.
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/
Correspondence to: Zhong-Gao Wang, MD, Professor, Academician, Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China. wangzg35@126.com
Telephone: +86-10-62015718
Received: November 3, 2016
Peer-review started: November 4, 2016
First decision: January 10, 2017
Revised: January 21, 2017
Accepted: February 17, 2017
Article in press: February 17, 2017
Published online: May 21, 2017
Abstract
AIM

To compare the outcomes between laparoscopic Nissen fundoplication (LNF) and proton pump inhibitors (PPIs) therapy in patients with laryngopharyngeal reflux (LPR) and type I hiatal hernia diagnosed by oropharyngeal pH-monitoring and symptom-scale assessment.

METHODS

From February 2014 to January 2015, 70 patients who were diagnosed with LPR and type I hiatal hernia and referred for symptomatic assessment, oropharyngeal pH-monitoring, manometry, and gastrointestinal endoscopy were enrolled in this study. All of the patients met the inclusion criteria. All of the patients underwent LNF or PPIs administration, and completed a 2-year follow-up. Patients’ baseline characteristics and primary outcome measures, including comprehensive and single symptoms of LPR, PPIs independence, and satisfaction, and postoperative complications were assessed. The outcomes of LNF and PPIs therapy were analyzed and compared.

RESULTS

There were 31 patients in the LNF group and 39 patients in the PPI group. Fifty-three patients (25 in the LNF group and 28 in the PPI group) completed reviews and follow-up. Oropharyngeal pH-monitoring parameters were all abnormal with high acid exposure, a large amount of reflux, and a high Ryan score, associated reflux symptom index (RSI) score. There was a significant improvement in the RSI and LPR symptom scores after the 2-year follow-up in both groups (P < 0.05), as well as typical symptoms of gastroesophageal reflux disease. Improvement in the RSI (P < 0.005) and symptom scores of cough (P = 0.032), mucus (P = 0.011), and throat clearing (P = 0.022) was significantly superior in the LNF group to that in the PPI group. After LNF and PPIs therapy, 13 and 53 patients achieved independence from PPIs therapy (LNF: 44.0% vs PPI: 7.14%, P < 0.001) during follow-up, respectively. Patients in the LNF group were more satisfied with their quality of life than those in the PPI group (LNF: 62.49 ± 28.68 vs PPI: 44.36 ± 32.77, P = 0.004). Body mass index was significantly lower in the LNF group than in the PPI group (LNF: 22.2 ± 3.1 kg/m2vs PPI: 25.1 ± 2.9 kg/m2, P = 0.001).

CONCLUSION

Diagnosis of LPR should be assessed with oropharyngeal pH-monitoring, manometry, and the symptom-scale. LNF achieves better improvement than PPIs for LPR with type I hiatal hernia.

Keywords: Laryngopharyngeal reflux, Hiatal hernia, Laparoscopic Nissen fundoplication, Proton pump inhibitor, pH-monitoring, Gastroesophageal reflux disease

Core tip: Laryngopharyngeal reflux disease is often associated with hiatal hernia and gastroesophageal reflux disease. Although the role of oropharyngeal pH-monitoring in the diagnosis of laryngopharyngeal reflux is clear, little is known regarding the anti-acid and anti-reflux therapeutic outcome by pH-monitoring and symptom-scale diagnosis. Laparoscopic Nissen fundoplication and proton pump inhibitors (PPIs) are effective in patients with laryngopharyngeal reflux and type I hiatal hernia. Nissen fundoplication shows better symptom relief than PPIs administration, and it also controls body mass index of patients. Our findings shed new insight into diagnosis and management for patients with laryngopharyngeal reflux disease.