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Abstract
Introduction Previously we have reported short term improvement in asthma related quality of life (AQLQ) and cough scores following anti-reflux surgery in asthma and chronic cough patients with gastro-oesophageal reflux disease (GORD) that did not respond to medical treatment. Herein we report on long-term outcome data.
Method A database of respiratory patients undergoing anti-reflux surgery was set up to assess GORD and respiratory symptoms at baseline, 3 months and long-term (mean 5 years). Data on lung function was also collected.
Results Twenty-eight patients (71% female, mean age = 50.1 years) completed an AQLQ (13 asthmatics) or cough score questionnaire (15 chronic cough patients) at a mean of 66 months following surgery (range = 6–100 months). The Hull reflux cough questionnaire (HRCQ) was also completed. All had significant reflux at baseline confirmed with oesophageal manometry and pH studies (mean DeMeester score of 47.26 [normal < 14.72], mean lower oesophageal sphincter pressure of 4.6mmHg [normal = 12–25] and a mean reflux time of 11.7% [normal < 4%]). The mean baseline FEV1 in the asthma group was 2.22 L (76% predicted) with a mean FEV1/FVC of 74%. In the cough group, mean FEV1 at baseline was 2.45 L (90% predicted) with a mean FEV1/FVC of 84%.
In the asthma group there was significant improvement in mean AQLQ (7 = best, 0 = worst) from baseline of 3.29 (SD=1.1) to 4.38 (SD=1.2) at 3 months and 4.44 (SD=1.4) long term (Figure 1). In the cough group, cough scores (0 = no cough and 10 = worst cough) significantly improved from a baseline mean of 7.3 (SD=1.9) to 2.6 (SD=3) at 3 months and 3.9 (SD=3.1) long term (Figure 1). In the asthma group we also observed an improvement in the mean HRCQ (0 = no reflux, 70 = worst reflux) from 49.2 (SD 13.8) at baseline to 22 (SD 13.9) long-term, without corresponding improvement in FEV1.
Conclusion Anti-reflux surgery provides sustainable long-term benefit to patients with significant GORD and poorly controlled asthma or chronic cough. These data require further confirmation in controlled trials.
(A) Longterm effect of antireflux surgery on cough score, (B) Longterm effect of anti-reflux surgery on AQLQ