The gastro-esophageal prolapse in GERD : clinical patterns and surgical outcome.

Aims. To assess the clinical profile of patients with gastro-esophageal prolapse and GERD and the outcome of surgical therapy. Methods. Since 1983 to 2006, 50 patients, mean age 48.84, r. 27-73 were observed. The severity of symptoms and Reflux esophagitis were graded from 0 to 3. The anatomy of the gejunction was assessed by barium swallow. Results. Median symptoms duration was 51 months (r. 2~300). Epigastric pain was in 98% of pts. Belching or gagging in 70% (35/50), Sl=38, 76%; S2=11, 22%, SR3=31, 62%; SR2=19, 38%. Reflux esophagitis in 94% (47/50; El=15, 30%; E2= 21, 42%; E3=11, 22%). At barium swallow 18 pts (36%) had normal anatomy, 11 (22%) had Sliding Hiatus Ernia, while in 21 pts (42%) the oral migration of the g-e junction. NissenFundoplication was performed in 28 (56%) with 2 Collis techniques. No mortality, morbility (7,1%), (Median FU 15 months, r 6-192 ). 22 patients underwent medical therapy (Median FU 60 months, r 24-120). Postoperative symptoms and reflux esophagitis improved statistically after surgery and after medical treatment (Preoperative versus Postoperative p = 0.000). In the comparison between surgical versus medical patients statistically significant differences were observed with regard to severity of pre-treatment reflux symptoms (p = 0.034) and with regard to post-treatment clinical evaluation of symptoms and esophagitis (p = 0.000). Conclusions. Epigastric pain, belching and gagging seem to be related to the g-e prolapse because they are reduced more by surgery than by antacid therapy. In g-e prolapse+GERD, surgery is more effective than medical therapy.