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William E. Johnson, MD; Jeffrey A. Hagen, MD; Tom R. DeMeester, MD; Werner K. H. Kauer, MD; Manfred P. Ritter, MD; Jeffrey H. Peters, MD; Cedric G. Bremner, MD

Arch Surg. 1996;131(5):489-492.

Abstract
Objective
To investigate factors predictive of relief of respiratory symptoms associated with gastroesophageal reflux disease (GERD).

Design
A case series of patients with GERD and respiratory symptoms undergoing fundoplication from 1987 to 1994 at a tertiary care university hospital.

Patients
Of 118 patients undergoing fundoplication for cardinal symptoms of GERD, 63 had respiratory symptoms. Postoperative follow-up information was available in 50 patients at a median of 3 years.

Interventions
The presence of GERD was documented on the basis of barium swallow, esophagoscopy, esophageal manometry, and 24-hour pH studies. A standardized questionnaire was used to score symptoms. A Nissen fundoplication was performed in 39 patients, a Collis-Belsey procedure in 8, and a Belsey fundoplication in 3 patients.

Main Outcome Measures
A repeat standardized questionnaire was used to evaluate the response to surgery for each symptom experienced. Univariate analysis was performed to evaluate factors influencing outcome.

Results
Respiratory symptoms were present in 53% (63/118) of patients with GERD. Fundoplication relieved the respiratory symptoms in 76% (38/50) of the patients. Reflux symptoms were relieved in 86% (43/50) of the patients. Abnormalities of esophageal motility were present in 34% (17/50) of the patients, and these were significantly more common in patients who did not experience relief of their respiratory symptoms (9/12 vs 8/38, x²=9.54, P=.002).

Conclusions
Respiratory symptoms are common in patients with GERD. Unlike classic reflux symptoms, the beneficial effects of antireflux surgery on respiratory symptoms are less predictable. The probability of relief of these respiratory symptoms with antireflux surgery is directly dependent on esophageal motor function.

(Arch Surg. 1996;131:489-492)

Author Affiliations
From the Department of Surgery, Division of Cardiovascular and Thoracic Surgery, University of Southern California School of Medicine, Los Angeles.

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