Outcome of Stretta radiofrequency and fundoplication for GERD-related severe asthmatic symptoms

Abstract

This study aimed to investigate the outcome of treatment with Stretta radiofrequency (SRF) or laparoscopic Nissen fundoplication (LNF). A total of 137 gastroesophageal reflux disease (GERD) patients with severe asthmatic symptoms who responded inadequately to medical treatment for asthma were investigated. The patients were followed up 1 year and 5 years after SRF (n = 82) or LNF (n = 55) treatment. A questionnaire covering 29 related symptoms and medication use was employed. Digestive, respiratory, and ear-nose-throat (ENT) symptom scores significantly decreased after antireflux treatment. Symptom scores respectively changed from 17.2±10.1, 31.9±6.6, and 21.1±11.8 to 5.0±6.2, 11.5±10.2, and 6.3±6.8 at 1 year and to 5.6±6.5, 13.1±10.1, and 7.8±7.2 at 5 years (P <0.001). The outcome of LNF was significantly better than that of SRF in terms of digestive (P <0.001, P = 0.001), respiratory (P = 0.006, P = 0.001), and ENT symptoms (P = 0.006, P = 0.003) at both 1 year and 5 years. SRF and LNF were both effective against the digestive symptoms of GERD as well as GERD-related severe asthmatic and ENT symptoms, with better outcomes exhibited by the LNF group. Severe asthmatic symptoms and GERD were closely associated, and this finding warrants further study.

Keywords

asthma / gastroesophageal reflux / Stretta radiofrequency / laparoscopic Nissen fundoplication

References

[1] Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R; Global Consensus Group.The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol 2006; 101(8): 1900–1920, quiz 1943

[2] Goh KL. Gastroesophageal reflux disease in Asia: a historical perspective and present challenges. J Gastroenterol Hepatol 2011; 26(Suppl 1): 2–10

[3] Havemann BD, Henderson CA, El-Serag HB. The association between gastro-oesophageal reflux disease and asthma: a systematic review. Gut 2007; 56(12): 1654–1664

[4] Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol 2013; 108(3): 308–328, quiz 329

[5] Wang ZG. It is gastroesophageal reflux disease, not asthma: a case report. Chin Med Sci J 2006; 21(3): 189–193

[6] Wang Z, Kotwal RM. Is GERD-induced asthma a different disease entity? Ther Adv Respir Dis 2012; 6(1): 57

[7] Wang ZG, Hu ZW, Wu JM, Liu JJ, Tian SR, Ji F, Li ZT. The interventional treatment on extra-esophageal symptoms: preliminary experience on 2016 patients. In: Proceedings of the J Gastroen Hepatol. Hoboken: Wiley-Blackwell, 2013: 305

[8] Fass R, Fennerty MB, Johnson C, Camargo L, Sampliner RE. Correlation of ambulatory 24-hour esophageal pH monitoring results with symptom improvement in patients with noncardiac chest pain due to gastroesophageal reflux disease. J Clin Gastroenterol 1999; 28(1): 36–39

[9] Gao X, Wang ZG, Wu JM, Ji F, Zhang CC, Ning YC, Li ZT, Hu ZW, Chen X, Tian SR. Radiofrequency treatment on respiratory symptoms due to gastroesophageal reflux disease. Chin Med J (Engl) 2011; 124(7): 1006–1009

[10] Wang ZG, Ji F, Wu JM, Lai YG, Gao X, Zhang CC.Effect of laparoscopic fundoplication treatment on gastroesophageal reflux disease-related respiratory symptoms. Front Med China 2010; 4: 254–258

[11] Zhang C, Wang ZG, Wu JM, Lai Y, Ji F, Gao X, Hu Z, Zhu G, Ning Y, Li Z, Liu H, Zhao J. A preliminary investigation of laparoscopic fundoplication treatment on gastroesophageal reflux disease-related respiratory symptoms. Surg Laparosc Endosc Percutan Tech 2012; 22(5): 406–409

[12] Wang ZG, Wu JM, Liu JJ, Wang LY, Lai YG, Ibrahim IM, Wang XJ, Dardik H. Respiratory distress resulting from gastroesophageal reflux is not asthma, but laryngotracheal irritation, spasm, even suffocation. Chin Med Sci J 2009; 24(2): 130–132

[13] Sacco O, Silvestri M, Sabatini F, Sale R, Moscato G, Pignatti P, Mattioli G, Rossi GA. IL-8 and airway neutrophilia in children with gastroesophageal reflux and asthma-like symptoms. Respir Med 2006; 100(2): 307–315

[14] Zhu GC, Gao X, Wang ZG, Hu ZW, Zhang CC, Lai YG, Ji F, Wu JM. Experimental study for the mechanism of gastroesophageal-reflux-associated asthma. Dis Esophagus 2014; 27(4): 318–324

[15] Rosztóczy A, Makk L, Izbéki F, Róka R, Somfay A, Wittmann T. Asthma and gastroesophageal reflux: clinical evaluation of esophago-bronchial reflex and proximal reflux. Digestion 2008; 77(3-4): 218–224

[16] Melvin WS. Modern treatment for gastroesophageal reflux disease: surgery vs medication. Arch Surg 2011; 146(9): 1093–1094

[17] McCallister JW, Parsons JP, Mastronarde JG. The relationship between gastroesophageal reflux and asthma: an update. Ther Adv Respir Dis 2011; 5(2): 143–150

[18] DeMeester TR, Bonavina L, Albertucci M. Nissen fundoplication for gastroesophageal reflux disease. Evaluation of primary repair in 100 consecutive patients. Ann Surg 1986; 204(1): 9–20

[19] Perrin-Fayolle M, Gormand F, Braillon G, Lombard-Platet R, Vignal J, Azzar D, Forichon J, Adeleine P. Long-term results of surgical treatment for gastroesophageal reflux in asthmatic patients. Chest 1989; 96(1): 40–45

[20] Field SK, Gelfand GA, McFadden SD. The effects of antireflux surgery on asthmatics with gastroesophageal reflux. Chest 1999; 116(3): 766–774

[21] McCormick DG. Stretta procedure for the treatment of gastroesophageal reflux disease. Gastroenterol Nurs 2004; 27(1): 22–28, quiz 29–30

[22] Wang ZG, Liu JJ, Chen X, Wu JM, Wang LY, Gong Y, Bai J, Dong YY, Hu YH, Lai YG. Discovery of gastroesophago-larygotracheal syndrome (GELTS)—summing-up on treating 200 GERD patients with Stretta radiofrequency. Clin Misdiagnosis Mistherapy 2007; 20(5): 1–4,99 (in Chinese)

[23] von Mutius E, Drazen JM. A patient with asthma seeks medical advice in 1828, 1928, and 2012. N Engl J Med 2012; 366(9): 827–834

[24] Comay D, Adam V, da Silveira EB, Kennedy W, Mayrand S, Barkun AN. The Stretta procedure versus proton pump inhibitors and laparoscopic Nissen fundoplication in the management of gastroesophageal reflux disease: a cost-effectiveness analysis. Can J Gastroenterol 2008; 22(6): 552–558

[25] Liang WT, Wu JM, Hu ZW, Wang ZG, Zhu GC, Zhang C. Laparoscopic Nissen fundoplication is more effective in treating patients with GERD-related chronic cough than Stretta radiofrequency. Minerva Chir 2014; 69(3): 121–127

[26] Wang VS, Feldman N, Maurer R, Burakoff R. Esophageal motility in nonacid reflux compared with acid reflux. Dig Dis Sci 2009; 54(9): 1926–1932

[27] Mainie I, Tutuian R, Shay S, Vela M, Zhang X, Sifrim D, Castell DO. Acid and non-acid reflux in patients with persistent symptoms despite acid suppressive therapy: a multicentre study using combined ambulatory impedance-pH monitoring. Gut 2006; 55(10): 1398–1402

[28] del Genio G, Tolone S, del Genio F, Rossetti G, Brusciano L, Pizza F, Fei L, del Genio A. Total fundoplication controls acid and nonacid reflux: evaluation by pre- and postoperative 24-h pH-multichannel intraluminal impedance. Surg Endosc 2008; 22(11): 2518–2523

[29] Harding SM, Guzzo MR, Richter JE. The prevalence of gastroesophageal reflux in asthma patients without reflux symptoms. Am J Respir Crit Care Med 2000; 162(1): 34–39

[30] Kiljander TO, Laitinen JO. The prevalence of gastroesophageal reflux disease in adult asthmatics.Chest2004; 126(5): 1490–1494 

Compliance with ethics guidelines

Zhiwei Hu, Jimin Wu, Zhonggao Wang, Yu Zhang, Weitao Liang, and Chao Yan declare no potential conflicts of interest. All procedures were in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1975, as revised in 2000(5). Informed consent was obtained from all patients included in the study.

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