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Frontiers of Medicine

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Front. Med.    2015, Vol. 9 Issue (4) : 437-443    https://doi.org/10.1007/s11684-015-0422-y
RESEARCH ARTICLE
Outcome of Stretta radiofrequency and fundoplication for GERD-related severe asthmatic symptoms
Zhiwei Hu,Jimin Wu,Zhonggao Wang(),Yu Zhang,Weitao Liang,Chao Yan
Department of Gastroesophageal Reflux Disease, the Second Artillery General Hospital PLA, Beijing 100088, China
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Abstract

This study aimed to investigate the outcome of treatment with Stretta radiofrequency (SRF) or laparoscopic Nissen fundoplication (LNF). A total of 137 gastroesophageal reflux disease (GERD) patients with severe asthmatic symptoms who responded inadequately to medical treatment for asthma were investigated. The patients were followed up 1 year and 5 years after SRF (n = 82) or LNF (n = 55) treatment. A questionnaire covering 29 related symptoms and medication use was employed. Digestive, respiratory, and ear-nose-throat (ENT) symptom scores significantly decreased after antireflux treatment. Symptom scores respectively changed from 17.2±10.1, 31.9±6.6, and 21.1±11.8 to 5.0±6.2, 11.5±10.2, and 6.3±6.8 at 1 year and to 5.6±6.5, 13.1±10.1, and 7.8±7.2 at 5 years (P <0.001). The outcome of LNF was significantly better than that of SRF in terms of digestive (P <0.001, P = 0.001), respiratory (P = 0.006, P = 0.001), and ENT symptoms (P = 0.006, P = 0.003) at both 1 year and 5 years. SRF and LNF were both effective against the digestive symptoms of GERD as well as GERD-related severe asthmatic and ENT symptoms, with better outcomes exhibited by the LNF group. Severe asthmatic symptoms and GERD were closely associated, and this finding warrants further study.
Keywords asthma      gastroesophageal reflux      Stretta radiofrequency      laparoscopic Nissen fundoplication     
Corresponding Author(s): Zhonggao Wang   
Just Accepted Date: 09 November 2015   Online First Date: 17 November 2015    Issue Date: 26 November 2015
 Cite this article:   
Zhiwei Hu,Jimin Wu,Zhonggao Wang, et al. Outcome of Stretta radiofrequency and fundoplication for GERD-related severe asthmatic symptoms[J]. Front. Med., 2015, 9(4): 437-443.
 URL:  
https://academic.hep.com.cn/fmd/EN/10.1007/s11684-015-0422-y
https://academic.hep.com.cn/fmd/EN/Y2015/V9/I4/437
Frequency of symptoms Severity of symptoms Score
No symptoms No symptoms 0
Less than once per week Slight symptoms 1
Once or twice per week Mild symptoms, uncomfortable but do not affect normal life 2
Three or four times per week Moderate symptoms that affect normal life and work 3
Five or six times per week Severe symptoms, very uncomfortable, partially incapacitating 4
More than six times per week Very severe symptoms, incapacitating or life-threatening, even requiring one or more rescue processes 5
Tab.1  Symptom frequency and severity scores
Characteristic/parameter SRF (n = 82) LNF (n = 55)
Male/female 33/49 27/28
Age (year) 49.1 (20–74) 48.2 (29–69)
Smoker/nonsmoker 7/65 6/49
Lung function tests n = 76 n = 49
FEV1, L (% predicted) 1.59±0.8 (63.5±23.8) 1.59±0.8 (60.1±26.8)
FEF, L/s (% predicted) 4.6±2.7 (67.1±25.3) 4.6±2.7 (70.0±29.2)
FEV1/FVC<70% 37 (45.1%) 23 (41.8%)
Endoscopy n = 72 n = 29
Esophagitis 14 (19.4%) 14 (48.3%)
LA-A 7 (9.7%) 7 (23.3%)
LA-B 5 (6.9%) 6 (20.0%)
LA-C 1 (1.4%) 1 (3.3%)
LA-D 0 (0%) 1 (3.3%)
Barrett esophagus 1 (1.4%) 0 (0%)
Hiatus hernia 0 12
Dual 24-h pH monitoring n = 67 n = 37
DMS (distal channel) 29.48±48.25 46.60±57.16
DMS>14.72 (distal channel) 37 (55.2%) 28 (75.7%)
DMS (proximal channel) 15.65±34.39 7.90±6.99
Esophageal manometry n = 64 n = 41
MUESP, mmHg (P%) 34.5±16.6 (50.0) 34.6±19.3 (56.1)
MLESP, mmHg (P%) 18.0±6.5 (18.8) 16.5±7.1 (31.7)
LHPZ, cm (P%) 3.2±3.8 (42.2) 2.8±0.6 (39.0)
Esophageal hypotonia, P% 45.3 51.2
Tab.2  Patient demographics and characteristics
Symptoms in questionnaire n (%) Symptom score (1 year) P value Symptom score (5 years) P value
Pre-treatment Post-treatment Pre-treatment Post-treatment
Acid regurgitation 111 (81.0%) 4.1±1.7 0.8±1.3 <0.001 4.1±1.7 1.0±1.4 <0.001
Food regurgitation 59 (43.1%) 3.4±1.7 0.6±1.1 <0.001 3.4±1.7 0.8±1.2 <0.001
Heartburn 101 (73.7%) 4.3±1.7 0.8±1.4 <0.001 4.3±1.7 1.1±1.5 <0.001
Chest pain 55 (40.1%) 4.1±1.7 1.4±1.7 <0.001 4.1±1.7 1.4±1.4 <0.001
Back pain 48 (35.0%) 4.4±1.9 1.6±1.9 <0.001 4.4±1.9 1.6±1.7 <0.001
Belching 57 (41.6%) 3.5±1.7 1.4±1.7 <0.001 3.5±1.7 1.5±1.5 <0.001
Hiccups 20 (14.6%) 4.4±2.0 1.5±2.0 <0.001 4.4±2.0 1.8±2.0 <0.001
Bloating 91 (66.4%) 4.6±1.8 1.8±2.0 <0.001 4.6±1.8 2.0±1.9 <0.001
Epigastric pain 19 (13.9%) 3.6±1.7 1.1±1.9 <0.001 3.6±1.7 1.2±1.7 <0.001
Digestive symptoms 133 (97.1%) 17.2±10.1 5.0±6.2 <0.001 17.2±10.1 5.6±6.5 <0.001
Cough 131 (89.1%) 7.0±1.7 2.4±2.5 <0.001 7.0±1.7 2.8±2.5 <0.001
Wheezing 137 (100%) 6.5±1.7 2.7±2.5 <0.001 6.5±1.7 2.9±2.4 <0.001
Chest tightness 122 (89.1%) 8.6±1.2 3.2±2.9 <0.001 8.6±1.2 3.5±2.8 <0.001
Expectoration 115 (83.9%) 8.4±1.5 2.9±2.9 <0.001 8.4±1.5 3.4±2.6 <0.001
Choking 25 (18.2%) 5.9±2.1 1.3±2.0 <0.001 5.9±2.1 1.8±1.9 <0.001
Shortness of breath 52 (38.0%) 7.0±1.9 2.8±2.9 <0.001 7.0±1.9 3.2±2.8 <0.001
Respiratory symptoms 137 (100%) 31.9±6.6 11.5±10.2 <0.001 31.9±6.6 13.1±10.1 <0.001
Earache 31 (22.6%) 3.9±1.8 1.2±2.0 <0.001 3.9±1.8 1.5±1.8 <0.001
Tinnitus 43 (31.4%) 3.5±1.6 1.5±1.8 <0.001 3.5±1.6 1.6±1.8 <0.001
Impaired hearing 31 (22.6%) 4.0±2.2 1.9±2.2 <0.001 4.0±2.2 2.2±2.2 <0.001
Nasal discharge 70 (51.1%) 4.5±1.7 1.6±1.9 <0.001 4.5±1.7 1.9±1.9 <0.001
Postnasal drip 9 (6.6%) 2.9±1.1 0.4±0.9 0.002 2.9±1.1 1.2±0.9 0.008
Nasal obstruction 52 (38.0%) 3.9±1.6 1.8±2.0 <0.001 3.9±1.6 2.0±1.9 <0.001
Sneezing 60 (43.8%) 4.0±1.8 1.6±1.9 <0.001 4.0±1.8 1.9±1.9 <0.001
Snoring 32 (23.4%) 3.7±1.4 1.3±1.9 <0.001 3.7±1.4 1.4±1.8 <0.001
Throat pain 37 (27.0%) 3.7±1.6 1.1±1.7 <0.001 3.7±1.6 1.3±1.7 <0.001
Globus sensation 66 (48.2%) 4.3±1.4 1.1±1.6 <0.001 4.3±1.4 1.5±1.3 <0.001
Throat clearing 27 (19.7%) 3.9±1.6 1.0±1.3 <0.001 3.9±1.6 1.4±1.2 <0.001
Throat tightness 76 (55.5%) 5.8±2.1 0.8±1.3 <0.001 5.8±2.1 1.1±1.3 <0.001
Throat itching 57 (41.6%) 4.1±1.3 1.0±1.4 <0.001 4.1±1.3 1.4±1.3 <0.001
Chronic hoarseness 31 (22.6%) 3.4±1.5 0.8±1.4 <0.001 3.4±1.5 0.9±1.2 <0.001
ENT symptoms 124 (90.5%) 21.1±11.8 6.3±6.8 <0.001 21.1±11.8 7.8±7.2 <0.001
Tab.3  Outcome of antireflux therapy over 12 months in terms of digestive, respiratory, and ENT symptoms
Fig.1  Comparison of the outcomes of different years and methods. (A and B) Percentage symptom score reduction was better 1 year after treatment than 5 years after treatment. (C and D) Notably better results were achieved in patients treated with LNF compared with SRF in terms of digestive, respiratory, and ENT symptoms. *P<0.05; **P<0.005.
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