Improved control of hypertension following laparoscopic fundoplication for gastroesophageal reflux disease

Abstract

This study aims to determine whether successful laparoscopic fundoplication for gastroesophageal reflux disease (GERD) can improve the control of hypertension. We conducted an observational study of GERD patients with hypertension. The esophageal and gastroesophageal symptoms of these patients were successfully treated with laparoscopic fundoplication, as measured by the reduced GERD symptoms and proton pump inhibitor consumption. A hypertension control scale was used to classify the use of antihypertensive medications and the quality of blood pressure control before and after anti-reflux surgery. Wilcoxon signed-ranks test was used for the statistical analyses. Seventy GERD patients were included in the analysis and followed up for a mean period of 3.5±1.4 years. Prior to surgery, all participating patients were taking at least one class of antihypertensive medication, and 56 patients (80%) had intermittently high blood pressure. After surgery, the mean number of antihypertensive medication classes per patient was significantly reduced from 1.61±0.77 pre-procedure to 1.27±0.88 post-procedure (P < 0.001). The blood pressure of 48 of the 56 cases (86%) with preoperative intermittent high blood pressure returned to normal post procedure. A total of 50 patients (71%) recorded improvements on the hypertension control scale, with the overall mean score decreasing from 3.1±1.0 pre-procedure to 1.4±1.0 post-procedure (P < 0.001). Therefore, successful laparoscopic fundoplication may result in better blood pressure control in some hypertensive GERD patients. This result suggests a possible connection between gastroesophageal reflux and hypertension.

Keywords

gastroesophageal reflux disease / hypertension / blood pressure / laparoscopic fundoplication

References

[1] 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

[2] El-Serag HB, Sweet S, Winchester CC, Dent J. Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut 2014; 63(6): 871–880

[3] Wang Z, Hu Z, Wu J, Ji F, Wang H, Lai Y, Gao X, Ning Y, Zhang C, Li Z, Liang W, Liu J. Insult of gastroesophageal reflux on airway: clinical significance of pharyngeal nozzle. Front Med 2015; 9(1): 117–122

[4] Malfertheiner P, Hallerbäck B. Clinical manifestations and complications of gastroesophageal reflux disease (GERD). Int J Clin Pract 2005; 59(3): 346–355

[5] McCormack T, Krause T, O'Flynn N. Management of hypertension in adults in primary care: NICE guideline. Br J Gen Pract 2012; 62(596): 163–164

[6] Gudlaugsdottir S, Verschuren W, Dees J, Stijnen T, Wilson J. Hypertension is frequently present in patients with reflux esophagitis or Barrett’s esophagus but not in those with non-ulcer dyspepsia. Eur J Intern Med 2002; 13(6): 369–375

[7] Peters JH. Surgical treatment of gastroesophageal reflux disease. Gastroenterol Hepatol (N Y) 2014; 10(4): 247–248

[8] Frazzoni M, Piccoli M, Conigliaro R, Frazzoni L, Melotti G. Laparoscopic fundoplication for gastroesophageal reflux disease. World J Gastroenterol 2014; 20(39): 14272–14279

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

[10] Hu ZW, Wu JM, Liang WT, Wang ZG. Gastroesophageal reflux disease related asthma: from preliminary studies to clinical practice. World J Respirol 2015; 5(1): 58–64

[11] Stefanidis D, Hope WW, Kohn GP, Reardon PR, Richardson WS, Fanelli RD; SAGES Guidelines Committee. Guidelines for surgical treatment of gastroesophageal reflux disease. Surg Endosc 2010; 24(11): 2647–2669

[12] Liang WT, Wu JN, Wang F, Hu ZW, Wang ZG, Ji T, Zhan XL, Zhang C. Five-year follow-up of a prospective study comparing laparoscopic Nissen fundoplication with Stretta radiofrequency for gastroesophageal reflux disease. Minerva Chir 2014; 69(4): 217–223

[13] Liang WT, Yan C, Wang ZG, Wu JM, Hu ZW, Zhan XL, Wang F, Ma SS, Chen MP. Early and midterm outcome after laparoscopic fundoplication and a minimally invasive endoscopic procedure in patients with gastroesophageal reflux disease: a prospective observational study. J Laparoendosc Adv Surg Tech A 2015; 25(8): 657–661

[14] Hu ZW, Wang ZG, Zhang Y, Wu JM, Liang WT, Yang Y, Tian SR, Wang AE. A preliminary investigation of anti-reflux intervention for gastroesophageal reflux related childhood-to-adult persistent asthma. Ann Surg Innov Res 2014; 8(1): 3

[15] Hu Z, Wu J, Wang Z, Zhang Y, Liang W, Yan C. Outcome of Stretta radiofrequency and fundoplication for GERD-related severe asthmatic symptoms. Front Med 2015; 9(4): 437–443

[16] Adams ST, Salhab M, Hussain ZI, Miller GV, Leveson SH. Obesity-related hypertension and its remission following gastric bypass surgery — a review of the mechanisms and predictive factors. Blood Press 2013; 22(3): 131–137

[17] Dorresteijn JA, Visseren FL, Spiering W. Mechanisms linking obesity to hypertension. Obes Rev 2012; 13(1): 17–26

[18] Hajer GR, van Haeften TW, Visseren FL. Adipose tissue dysfunction in obesity, diabetes, and vascular diseases. Eur Heart J 2008; 29(24): 2959–2971

[19] Liuzzo JP, Ambrose JA. Chest pain from gastroesophageal reflux disease in patients with coronary artery disease. Cardiol Rev 2005; 13(4): 167–173

[20] Alexandre L, Broughton T, Loke Y, Beales IL. Meta-analysis: risk of esophageal adenocarcinoma with medications which relax the lower esophageal sphincter. Dis Esophagus 2012; 25(6): 535–544

[21] Mellow MH, Simpson AG, Watt L, Schoolmeester L, Haye OL. Esophageal acid perfusion in coronary artery disease. Induction of myocardial ischemia. Gastroenterology 1983; 85(2): 306–312

[22] Davies HA, Page Z, Rush EM, Brown AL, Lewis MJ, Petch MC. Oesophageal stimulation lowers exertional angina threshold. Lancet 1985; 325(8436): 1011–1014

[23] Garcia-Pulido J, Patel PH, Hunter WC, Douglas JE, Thomas E. Esophageal contribution to chest pain in patients with coronary artery disease. Chest 1990; 98(4): 806–810

[24] Singh S, Richter JE, Hewson EG, Sinclair JW, Hackshaw BT. The contribution of gastroesophageal reflux to chest pain in patients with coronary artery disease. Ann Intern Med 1992; 117(10): 824–830

[25] Cuomo R, De Giorgi F, Adinolfi L, Sarnelli G, Loffredo F, Efficie E, Verde C, Savarese MF, Usai P, Budillon G. Oesophageal acid exposure and altered neurocardiac function in patients with GERD and idiopathic cardiac dysrhythmias. Aliment Pharmacol Ther 2006; 24(2): 361–370

[26] Ji F, Wang ZG, Wu JM, Gao X, Chen X. The Stretta procedure eliminates arrhythmia due to gastroesophageal reflux disease. Gastroenterol Nurs 2010; 33(5): 344–346

[27] Bredenoord AJ. Mechanisms of reflux perception in gastroesophageal reflux disease: a review. Am J Gastroenterol 2012; 107(1): 8–15

[28] Chrysos E, Athanasakis E, Pechlivanides G, Tzortzinis A, Mantides A, Xynos E. The effect of total and anterior partial fundoplication on antireflux mechanisms of the gastroesophageal junction. Am J Surg 2004; 188(1): 39–44

[29] Canning BJ, Mazzone SB. Reflex mechanisms in gastroesophageal reflux disease and asthma. Am J Med 2003; 115(Suppl 3A): 45S–48S

[30] Chakraborty TK, Ogilvie AL, Heading RC, Ewing DJ. Abnormal cardiovascular reflexes in patients with gastro-oesophageal reflux. Gut 1989; 30(1): 46–49

[31] Rosztóczy A, Vass A, Izbéki F, Nemes A, Rudas L, Csanády M, Lonovics J, Forster T, Wittmann T. The evaluation of gastro-oesophageal reflux and oesophagocardiac reflex in patients with angina-like chest pain following cardiologic investigations. Int J Cardiol 2007; 118(1): 62–68

[32] Swiatkowski M, Budzyński J, Kłopocka M, Grad K, Pulkowski G, Augustyńska B, Suppan K, Fabisiak J. The effect of eight weeks of rabeprazole therapy on nitric oxide plasma level and esophageal pH and motility and motility nitric oxide plasma level in patients with erosive esophagitis. Med Sci Monit 2004; 10(2): CR46–CR51

Acknowledgements

This study is supported by Beijing Municipal Science and Technology Commission (No. Z141107002514109).

Compliance with ethics guidelines

Zhiwei Hu, Meiping Chen, Jimin Wu, Qing Song, Chao Yan, Xing Du, and Zhonggao Wang 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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