Magnetic sphincter augmentation is an effective treatment for atypical symptoms caused by gastroesophageal reflux disease

Abstract

Background

The purpose of this study was to determine whether magnetic sphincter augmentation (MSA) could effectively treat patients with gastroesophageal reflux disease (GERD) who suffer primarily from atypical symptoms due to laryngopharyngeal reflux (LPR). MSA has been shown to treat typical symptoms of GERD with good success, but its effect on atypical symptoms is unknown.

Methods

A retrospective review of a prospectively maintained institutional review board-approved database was conducted for all patients who underwent MSA between January 2015 and December 2018. All patients had objective confirmation of GERD from ambulatory pH monitoring off anti-reflux medications (DeMeester score > 14.7). Symptoms were assessed preoperatively and at 1 year postoperatively using GERD Health-Related Quality of Life (GERD–HRQL) and Reflux Symptom Index (RSI) questionnaires.

Results

There were 86 patients (38 males; 48 females) with a median age of 51.5 years. Total GERD HRQL scores improved from a mean of 38.79 to 6.53 (p < 0.01) and RSI scores improved from a mean of 20.9 to 8.1 (p < 0.01). Atypical symptoms evaluated from the RSI questionnaire include hoarseness, throat clearing, postnasal drip, breathing difficulties, and cough. All atypical symptoms were significantly improved at 1 year following MSA (p < 0.01). All three typical symptoms of heartburn, dysphagia, and regurgitation were significantly improved based on pre and postoperative GERD HRQL questionnaires (p < 0.02). Ninety-one percent of patients were off their PPI and dissatisfaction with their current therapy decreased from 95% preoperatively to 13% postoperatively.

Conclusion

MSA is an effective treatment for typical and atypical GERD symptoms.

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Correspondence to Marc A. Ward.

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Disclosures

Dr. Leeds is a consultant for Ethicon & LINX device. Dr. Ward, Mr. Ebrahim, Dr. Kopita, Dr. Arviso, Dr. Ogola, and Ms. Buckmaster have no conflicts of interest or financial ties to disclose.

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Ward, M.A., Ebrahim, A., Kopita, J. et al. Magnetic sphincter augmentation is an effective treatment for atypical symptoms caused by gastroesophageal reflux disease. Surg Endosc 34, 4909–4915 (2020). https://doi.org/10.1007/s00464-019-07278-9

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Keywords

  • Magnetic sphincter augmentation
  • Gastroesophageal reflux disease (GERD)
  • Atypical symptoms
  • Laryngopharyngeal reflux disease (LPR)
  • Ambulatory pH testing