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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

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Front. Med.    2017, Vol. 11 Issue (1) : 68-73    https://doi.org/10.1007/s11684-016-0490-7
RESEARCH ARTICLE
Improved control of hypertension following laparoscopic fundoplication for gastroesophageal reflux disease
Zhiwei Hu1,Meiping Chen1,Jimin Wu1,Qing Song1,Chao Yan2,Xing Du2,Zhonggao Wang1,2()
1. Department of Gastroesophageal Reflux Disease, PLA Rocket Force General Hospital, Beijing 100088, China
2. Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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Abstract

This study aims to determine whether successful laparoscopic fundoplication for gastroesophageal reflux disease (GERD) can improve the control of hypertension. We conducted an observational study of GERD patients with hypertension. The esophageal and gastroesophageal symptoms of these patients were successfully treated with laparoscopic fundoplication, as measured by the reduced GERD symptoms and proton pump inhibitor consumption. A hypertension control scale was used to classify the use of antihypertensive medications and the quality of blood pressure control before and after anti-reflux surgery. Wilcoxon signed-ranks test was used for the statistical analyses. Seventy GERD patients were included in the analysis and followed up for a mean period of 3.5±1.4 years. Prior to surgery, all participating patients were taking at least one class of antihypertensive medication, and 56 patients (80%) had intermittently high blood pressure. After surgery, the mean number of antihypertensive medication classes per patient was significantly reduced from 1.61±0.77 pre-procedure to 1.27±0.88 post-procedure (P?<?0.001). The blood pressure of 48 of the 56 cases (86%) with preoperative intermittent high blood pressure returned to normal post procedure. A total of 50 patients (71%) recorded improvements on the hypertension control scale, with the overall mean score decreasing from 3.1±1.0 pre-procedure to 1.4±1.0 post-procedure (P?<?0.001). Therefore, successful laparoscopic fundoplication may result in better blood pressure control in some hypertensive GERD patients. This result suggests a possible connection between gastroesophageal reflux and hypertension.
Keywords gastroesophageal reflux disease      hypertension      blood pressure      laparoscopic fundoplication     
Corresponding Author(s): Zhonggao Wang   
Just Accepted Date: 26 December 2016   Online First Date: 20 February 2017    Issue Date: 20 March 2017
 Cite this article:   
Zhiwei Hu,Meiping Chen,Jimin Wu, et al. Improved control of hypertension following laparoscopic fundoplication for gastroesophageal reflux disease[J]. Front. Med., 2017, 11(1): 68-73.
 URL:  
https://academic.hep.com.cn/fmd/EN/10.1007/s11684-016-0490-7
https://academic.hep.com.cn/fmd/EN/Y2017/V11/I1/68
Fig.1  Laparoscopic Nissen fundoplication. (A) After dissecting the gastro-hepatic ligament, a window was created behind the lower esophagus, the crura diaphragmatis were carefully dissected, and approximately 5 cm of the distal esophagus was mobilized. The gastric fundus was dissected by dividing the short gastric vessels. The crura diaphragmatis were sewed behind the esophagus with 2?4 non-absorbable sutures. (B) A posterior 360° and 1.5 to 2 cm long fundoplication was constructed with 2?3 interrupted non-absorbable stitches (Toupet fundoplication was created by a posterior 270° and 2-cm-long fundoplication with 6 interrupted non-absorbable sutures). Finally the fundus was attached to the crura diaphragmatis with 2 non-absorbable sutures.
Characteristic/parameter Total= 70
Male/female ( n/n) 37/33
Age ( year) 58.8±9.1 (38–78)
Smoker/nonsmoker ( n/n) 9/61
Body mass index 21.7±3.6 (16.3–29.0)
Preoperative MBP ( mmHg) (174±17)/(95±18)
Diagnose of hypertension (year) 11.3±8.1 (2–45)
History of GERD symptom( year) 10.4±9.1 (1–50)
Endoscopy
Esophagitis n = 55 (78.6%)
LA-A, LA-B, LA-C, LA-D n = 24, 18, 7, 6
Hiatus hernia n = 49 (70%)
24-h pH monitoring
De Meester score 26.4±15.1 (6.5–71.8)
De Meester score>14.72 n = 54 (77.1%)
Esophageal manometry
MLESP (mmHg) 10.7±7.2 (1.1–33.0)
MLESP<13 mmHg n = 55 (78.6%)
Major disorders of peristalsis n = 22 (31.4%)
Frequent failed peristalsis n = 20 (28.6%)
Absent contractility n = 2 (2.9%)
Tab.1  Patient demography and characteristics at the time of LF
GERD symptom Number of cases Symptom score Symptom score reduction rate (range) P value
Pre-surgery Post-surgery
Regurgitation 66 (94.3%) 6.6±0.8 0.8±1.1 88.1% (52.3%–100%) <0.001
Heartburn 65 (92.9%) 6.7±0.8 0.9±1.1 85.8% (51.8%–100%) <0.001
Chest pain 38 (54.3%) 6.3±0.7 0.7±1.2 88.9% (50.0%–100%) <0.001
Esophageal symptoms 66 (94.3%) 16.9±3.6 2.0±2.0 88.0% (54.6%–100%) <0.001
Cough 39 (55.7%) 7.1±1.2 1.0±1.3 87.0% (50.0%–100%) <0.001
Wheezing 37 (52.9%) 7.9±0.9 1.3±1.3 84.3% (50.0%–100%) <0.001
Extra-esophageal symptoms 39 (55.7%) 14.6±2.0 2.5±2.0 84.8% (53.3%– 100%) <0.001
Total GERD symptom score 70 (100%) 24.1±9.7 3.1±3.4 86.9% (54.1%–100%) <0.001
Tab.2  Outcomes of anti-reflux therapy for esophageal and extra-esophageal symptoms
Hypertension control scale Preoperative
n (%)		 Postoperative**
n (%)
0, normal blood pressure without medication 0 (0%) 13 (18.6%)
1, normal blood pressure with a single medication 9 (12.9%) 30 (42.9%)
2, normal blood pressure with multiple medications 5 (7.1%) 19 (27.1%)
3, intermittent hypertension with single medication 28 (40.0%) 4 (5.7%)
4, intermittent hypertension with multiple medications 28 (40.0%) 4 (5.7%)
Tab.3  Blood pressure control following LF
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