Introduction

Dysphagia is a possible complication of anti-reflux surgery. Whether absent peristalsis on pre-operative esophageal high-resolution manometry (HRM) increases the risk of post-operative dysphagia is unclear.

Aims & Methods

We compared dysphagia and gastro-esophageal disease (GERD) outcomes in patients with absent peristalsis and normal motility undergoing anti-reflux surgery. We enrolled consecutive patients with heartburn and proven GERD on pH-impedance monitoring undergoing Nissen or Toupet fundoplication. All patients underwent pre-operative HRM and pH-impedance monitoring, which were assessed according to Chicago Classification v4.0 and Lyon Consensus, respectively. Age, sex, presence of dysphagia, pH-impedance, and HRM findings were recorded pre-operatively. Post-operatively, all patients completed the following questionnaires: hospital odynophagia & dysphagia questionnaire (HODQ), reflux symptoms index (RSI), reflux disease questionnaire (RDQ), and the GERD-health related quality of life (GERD-HRQL). Data are described as median and interquartile range (Q1-Q3) or as counts and percent. Kruskal-Wallis Rank Sum Test was used for continuous data, and Pearson’s Chi-Square test and Fisher’s exact test for counts. Significance threshold was p<0.05.

Results

Fifty-seven consecutive patients were included, 27 (47.3%) with absent peristalsis (group A) and 30 (26.3%) normal motility (Group B). Nissen fundoplication was performed in 67% of group A and in 90% of group B, while Toupet fundoplication was performed in 33% of group A and 10% of group B. The two groups were comparable in age, sex, and prevalence of pre-operative dysphagia. Significantly more patients from group B underwent Nissen fundoplication (p=0.03). The overall median time interval between the surgery and questionnaires was 28 months (9-48), without significant differences between the groups. The scores of all the post-operative symptomatic outcome measures were comparable between the two groups. These results remained consistent even when only patients undergoing Nissen fundoplication were included in the analysis.

Conclusion

Patients with absent peristalsis do not have an increased risk of post-operative dysphagia and have similar GERD outcomes compared to patients with normal esophageal motility. Absent peristalsis on HRM should not be considered a contraindication for anti-reflux surgery in patients with proven GERD at pH-impedance.

Introduction

Helicobacter pylori (H. pylori) infection remains a major public health problem. Given the high resistance to antibiotics, different treatment strategies must be validated in each specific country. The recurrence rates of H. pylori infection and its predictors remain unclear.

Aims & Methods

To determine the independent factors predicting recurrence after successful eradication with a first-line treatment for H. pylori infection.
All patients were submitted to eradication treatment with five quadruple therapies (A-Concomitant with metronidazole 500mg tid, 14 days; B-Concomitant with metronidazole 500mg bid, 14 days; C-Quadruple with bismuth, 10 days; D-Sequential, 14 days; E-Hybrid, 14 days)) in a blind, randomized trial. Esomeprazole was the proton-pump inhibitor of choice. Efficacy rate at 1-2 months and recurrence rate at 12 months using ¹³C-urea breath test were evaluated. Sociodemographic data, personal/family history, health status and biochemical parameters were assessed using univariate and multivariate analyses.

Results

A total of 126 patients (42.9% males; mean age: 57.4±16.7 years) concluded the treatment protocol (A-25; B-21; C-27; D-24; E-29). Overall efficacy rate of quadruple therapy regimens was 98.4%(n=124): Group A-100%; Group B-100.0%; Group C-100.0%; Group D-100.0%; Group E-93.1% (p=0.147). Overall recurrence rate of quadruple therapy regimens was 4.1%(n=5/123): Group A-12.0%; Group B-9.5%; Group C-0.0%; Group D-0.0%; Group E-0.0% (p=0.009). After univariate/multivariate analysis, high LDL-cholesterol level (OR 1.032, p=0.042), non-bismuth concomitant H. pylori eradication regimen (OR 8.904, p=0.064) and alcoholism (OR 8.333, p=0.035) were independent risk factors for H. pylori reinfection.

Conclusion

In this South-European country, all quadruple therapy regimens with or without bismuth are very effective for H. pylori eradication. The 12-months recurrence rate of H. pylori infection after successful eradication is <5%. High LDL-cholesterol, non-bismuth concomitant H. pylori eradication regimen and alcoholism are independent predictors for H. pylori reinfection. A close surveillance on infectious state in high-risk patients is crucial to prevent long-term H. pylori-associated complications.

References

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Disclosure

None of the authors have anything to declare with regard to personal or financial interests in carrying out this work.