GERD Clinical Trial
Official title:
Effectiveness of Anti-reflux Surgery for the Cure of Chronic Cough Associated With Gastro-oesophageal Reflux Disease
The effectiveness of surgical fundoplication in treating classical reflux symptoms is well
documented, but the role of surgery in alleviating extra-esophageal symptoms allegedly
secondary to gastro-esophageal reflux disease (GORD) is far to be assessed.
The effectiveness of anti-reflux surgery on extra-esophageal reflux symptoms varies from 15%
to 95%; the spread of these data is largely attributable to disparate study design and
methodology, patient selection, and outcome metrics.
In order to assess whether anti-reflux surgery may have beneficial effects on chronic cough
allegedly secondary to GERD and to eventually identify the preoperative clinical profile
which could predict those positive effects, we considered two groups of patients presenting
with 1) GERD associated to chronic cough, 2), typical GERD who underwent anti-reflux
surgery.
Pre-operatively, patients routinely underwent the symptoms assessment, barium swallow, upper
gastro-intestinal endoscopy and esophageal manometry.
The type and severity of symptoms and the grade of reflux oesophagitis were scored using a
questionnaire with semi-quantitative scales.
The upper gastro-intestinal (GI) endoscopy, barium swallow and esophageal manometry were
performed according to standard techniques; reflux esophagitis was reported according to the
Los Angeles classification. In the absence of Los Angeles grade A or higher esophagitis,
patient underwent a 24h pH-recording or intraluminal impedance/pH monitoring. Patients
complaining of chronic cough were submitted to a specific work-up consisting of a chest High
Resolution Computed Tomography (HRCT) scan, methacholine challenge test and spirometry in
order to exclude pulmonary diseases.
Surgery was performed in patients negative for pulmonary diseases on chest HRCT scan, on
methacholine challenge test and spirometry, in consideration of the fact that patients had
been referred mainly for the therapy of chronic cough.
The study was started in 1995 and it was closed in 2010.
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Observational Model: Case-Only, Time Perspective: Prospective
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