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Bilan diagnostique du RGO: modalités en vue d’optimiser la chirurgie anti-reflux

Modalities of diagnostic work-up of GERD to make an antireflux operation successful

  • Mise Au Point
  • Published:
Acta Endoscopica

Résumé

Dans les pays occidentaux, le recours au traitement anti-reflux par chirurgie mini-invasive, a triplé au cours de ces 15 dernières années. Une telle progression n’a été possible que par une mise au point diagnostique efficace du reflux gastro-œsophagien (RGO) garante de la réussite du geste chirurgical. Le bilan pré-opératoire des patients doit prendre en compte les résultats de l’investigation endoscopique de même que les mécanismes physiopathologiques impliqués dans le reflux. Sur le plan anatomique, le RGO comprend 3 sous-groupes: le reflux non érosif, l’œsophagite érosive et l’œsophage de Barrett, ce dernier retenant toute l’attention en raison de son association à un risque d’adénocarcinome du cardia et de l’œsophage. Après chirurgie anti-reflux, le risque ultérieur de dégénérescence ne diffère pas significativement de celui des patients traités par IPP.

Le consensus concernant les tests physiopathologiques d’évaluation du RGO est le suivant qu’il y ait eu un geste chirurgical préalable ou non: pH-métrie de 24 h, manométrie œsophagienne, bilimétrie, et étude de la vidange gastrique par scintigraphie. L’impédancemétrie de même que la radiologie sont également contributives dans l’évaluation d’un œsophage court ou d’une volumineuse hernie hiatale. Enfin, le statut psychologique du patient est un facteur à prendre également en compte pour garantir le succès chirurgical.

Summary

Minimal antireflux access technique has tripled in Western countries with regard to the previous past 15 years. Such an increase requires a diagnostic work-up prior to surgical success. The preoperative evaluating of the patients has to take into account endoscopic data and pathophysiological mechanisms of the reflux. On an anatomical background the GERD is redefined in three subgroups: non erosive, erosive esophagitis, and Barrett’s esophagus, the latter being the main focus due to its association with adenocarcinoma of the cardia and the esophagus. The risk of develo** a cancer after antireflux surgery is not significantly different from proton pump therapy.

Consensus about diagnostic tests ranking monitoring of GERD, with previous surgery or not is: 24 hours pH-monitoring, esophageal manometry, bilimetry and gastric emptying scintigraphy. Impedance measurement is also contributive, as radiology for screening of a short esophagus or a large hiatal hernia. The psychological status of the patient should also be taken into account for a successful surgical result.

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Références

  1. Dallemagne B, Weerts JM, Jehaes C. Laparoscopic Nissen fundoplication: Preliminary reports. Surg Laparosc Endosc 1991;1:138–43.

    PubMed  CAS  Google Scholar 

  2. Dallemagne B, Weerts JM, Jehaes C, Markiewicz S. Causes of failures of laparoscopic antireflux operations. Surg Endosc 1996;10:305–10.

    Article  PubMed  CAS  Google Scholar 

  3. Grande L, Toledo-Pimentel V, Manterola C, Lacima G, Ros E, Garcia-Valdecasas JC, Fuster J, Visa J, Pera C. Value of Nissen fundoplication in patients with gastro-oesophageal reflux judged by long-term symptom control. Br J Surg 1994;81:548.

    Article  PubMed  CAS  Google Scholar 

  4. Jamieson GG, Watson DI, Britten-Jones R, Mitchell PC, Anvari M. Laparoscopic Nissen Fundoplication. Ann Surg 1994;220:137–45.

    Article  PubMed  CAS  Google Scholar 

  5. Fuchs KH, Heimbucher J, Freys SM, Thiede A. Management of gastro-esophageal reflux disease 1995. Tailored concept of anti-reflux operations. Dis Esoph 1995;7:250–4.

    Google Scholar 

  6. Perdikis G, Hinder RA, Lund RJ, Raiser F, Katada N. Laparoscopic Nissen fundoplication: Where do we stand? Surg Laparoscopy & Endoscopy 1997;7:117–21.

    Google Scholar 

  7. Fuchs KH. Conventional and minimally invasive surgical methods for gastroesophageal reflux. Chirurg 2005;76:370–8.

    Article  PubMed  Google Scholar 

  8. Hüttl TP, Hohle M, Meyer G, Schildberg FW. Antireflux surgery in Deutschland. Chirurg 2002;73(5):451–61.

    Article  PubMed  Google Scholar 

  9. Vigneri S, Termini R, Leandro G, Badalamenti S, Pantalena M, Savarino V, Di Mario F, Battaglia G, Mela GS, Pilotto A. A comparison of five maintenance therapies for reflux esophagitis. N Engl J Med 1995;326:1106–10.

    Article  Google Scholar 

  10. Klinkenberg-Knol EC, Nelis F, Dent J, et al. Long-term Omeprazole treatment in resistant gastroesophageal reflux disease: efficacy, safety, and influence on gastric mucosa. Gastroenterology 2000;,118:661–9.

    Article  PubMed  CAS  Google Scholar 

  11. Eypasch E, Neugebauer E, Fischer F, Troidl H. Laparoscopic antireflux surgery for gastroesophageal reflux disease (GERD). Results of a consensus development conference. Surg Endoscopy 1997;11:413–26.

    Article  Google Scholar 

  12. Fuchs KH, Feussner H, Bonavina L, Collard JM, Coosemans W for the European Study Group for Antireflux Surgery. Current status and trends in laparoscopic antireflux surgery: results of a consensus meeting. Endoscopy 1997;29:298–308.

    Article  PubMed  CAS  Google Scholar 

  13. Dent J, Brun J, Fendrick AM, Fennerry MB, Janssens J, et al. Genval Workshop Group: An evidence-based appraisal of reflux disease management. Gut 1999;44:S1–16.

    Article  Google Scholar 

  14. Catarci M, Gentileschi P, Papi C, Carrara A, Marrese R, Gaspari AL, Grassi GB. Evidence-based appraisal of anti-reflux fundoplication. Ann Surg 2004;239:325–37.

    Article  PubMed  Google Scholar 

  15. DeMeester TR, Johnson LF, Kent AH. Evaluation of current operations for the prevention of gastroesophageal reflux. Ann Surg 1974;180:511–25.

    PubMed  CAS  Google Scholar 

  16. Fuchs KH, Freys SM, Heimbucher J, Fein M, Thiede A. Pathophysiological spectrum in patients with gastroesophageal reflux disease in a surgical GI function laboratory. Diseases of the Esophagus 1995;8:211–7.

    Google Scholar 

  17. DeMeester TR, Johnson LS, Joseph GJ, Toscano MS, Hall AW, Skinner DB. Patterns of gastroesophageal reflux in health and disease. Ann Surg 1976;184:459–70.

    Article  PubMed  CAS  Google Scholar 

  18. Vaezi MF, Richter JE. Synergism of acid and duodeno-gastroesophageal reflux in complicated Barrett’s esophagus. Surgery 1995;117:699–704.

    Article  PubMed  CAS  Google Scholar 

  19. Fein M, Ireland AP, Ritter MP, Peters JH, Hagen JA, Bremner CG, DeMeester TR. Duodenogastric reflux potentiates the injurious effects of gastroesophageal reflux. J Gastrointest Surg 1997;1:27–33.

    Article  PubMed  CAS  Google Scholar 

  20. DeMeester TR. Definition, detection and pathophysiology of gastroesophageal reflux disease. In: International trends in general thoracic surgery, vol. 3 ed DeMeester TR, Matthews HR. Benign esophageal disease. Mosby St. Louis, 99–127, 1987.

    Google Scholar 

  21. Tack J, Koek G, Demedts I, Sifrim D, Janssens J. Gastroesophageal Reflux Disease Poorly Responsive to Single-Dose Proton Pump Inhibitors in Patients without Barrett’s Esophagus: Acid Reflux, Bile Reflux, or Both? Am J Gastroenterol 2004;99:981–8.

    Article  PubMed  CAS  Google Scholar 

  22. Zaninotto G, DeMeester TR, Schwizer W, Johansson KE, Cheng SC. The lower esophageal sphincter in health and disease. Am J Surg 1988;155:104–11.

    Article  PubMed  CAS  Google Scholar 

  23. Kennedy T, Jones R. The prevalence of gastroesophageal reflux symptoms in a UK population and the consultation behaviour of patients with these symptoms. Aliment Pharmacol Ther 2000;14:1589–94.

    Article  PubMed  CAS  Google Scholar 

  24. Schepp W, Allescher HD, Frieling T, Katschinski M, Malfertheiner P, Pehl C, Peitz U, Rösch W, Hotz J. GERD: definitions, epidemiology and natural course. Z Gastroenterol 2005;43:165–8.

    Article  PubMed  CAS  Google Scholar 

  25. Pera M, Cameron AJ, Trastek VF, Carpenter HA, Zinsmeister AR. Increasing incidence of adenocarcinoma of the esophagus and esophagogastric junction. Gastroenterology 1993;104:510–3.

    PubMed  CAS  Google Scholar 

  26. Lagergren J, Bergström R, Lindgren A, Nyrén O. Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med 1999;340:825–31.

    Article  PubMed  CAS  Google Scholar 

  27. DeMeester SR, DeMeester TR. Columnar mucosa and intestinal metaplasia of the esophagus: fifty-year controversy. Ann Surg 2000;231(2):303–21.

    Article  PubMed  CAS  Google Scholar 

  28. Corey KE, Schmitz SM, Shaheen NJ, Does a surgical anti-reflux procedure decrease the incidence of esophageal adenocarcinoma in Barrett’s esophagus? A meta-analysis. Am J Gastroenterol 2003;98(11):2390–4.

    Article  PubMed  Google Scholar 

  29. Klauser AG, Schindlbeck NE, Müller-Lissner SA. Symptoms in gastroesophageal reflux disease. Lancet 1990;335:205–8.

    Article  PubMed  CAS  Google Scholar 

  30. Breumelhof R, Smout AJ. The symptom sensitivity index: a valuable additional parameter in 24-hour esophageal pH recording. Am J Gastroenterol 1991;86:160–4.

    PubMed  CAS  Google Scholar 

  31. Costantini M, Crookes PF, Bremner RM, Hoeft SF, Ehsan A, Peters JH, Bremner CG, DeMeester TR. Value of physiological assessment of foregut symptoms in a surgical practice. Surgery 1993;114 (4):780–6.

    PubMed  CAS  Google Scholar 

  32. Campos GM, Peters JH, DeMeester TR, Oberg S, Crookes PF, Tan S, DeMeester SR, Hagen JA, Bremner CG. Multivariate analysis of factors predicting outcome after laparoscopic Nissen fundoplication. J Gastrointest Surg 1999;3(3):292–300.

    Article  PubMed  CAS  Google Scholar 

  33. Galmiche JP, Bruley des Varannes S. Endoscopy-negative reflux disease. Curr Gastroenterol Rep 2001;3:206–214.

    Article  PubMed  CAS  Google Scholar 

  34. Tutuian R, Vela MF, Shay SS, Castell DO. Multichannel intraluminal impedance in esophageal function testing and gastroesophageal reflux. Journal of Clinical Gastroenterology 2003;37(3):206–215.

    Article  PubMed  Google Scholar 

  35. Mainie I, Tutuian R, Shay S, Vela M, Zhang X, Sifrim D, Castell DO. Acid and non-acid reflux in patients with persistent symptoms despite acid suppressive therapy: a multicentre study using combined ambulatory impedance-pH monitoring. Gut 2006;55:1398–1402.

    Article  PubMed  CAS  Google Scholar 

  36. Lundell L, Abrahamsson H, Ruth M, Rydberg L, Lonroth H, Olbe L. Long-term results of a prospective randomized comparison of total fundic wrap (Nissen-Rossetti) or semifundoplication (Toupet) for gastro-oesophageal reflux. Br J Surg 1996;83(6):830–5.

    Article  PubMed  CAS  Google Scholar 

  37. Rydberg L, Ruth M, Lundell L. Does oesophageal motor function improve with time after successful antireflux surgery? Results of a prospective, randomized clinical study. Gut 1997;41:82–6.

    Article  PubMed  CAS  Google Scholar 

  38. Zornig C, Strate U, Fibbe C, Emmermann A, Layer P. Nissen vs Toupet laparoscopic fundoplication. Surg Endosc 2002;16(5):758–66.

    Article  PubMed  CAS  Google Scholar 

  39. Horvath KD, Jobe BA, Herron DM, Swanström LL. Laparoscopic Toupet fundoplication is an inadequate procedure for patients with severe reflux disease. J Gastrointest Surg 1999;3:583–91.

    Article  PubMed  CAS  Google Scholar 

  40. Hunter JG, Smith CD, Branum GD, et al. Laparoscopic fundoplication failures. Ann Surg 1999;230:595–606.

    Article  PubMed  CAS  Google Scholar 

  41. Kuster E, Ros E, Toledo-Pimentel V, Pujol A, Bordas JM, Grande IC. Predictive factors of the long term outcome in gastro-oesophageal reflux disease: six-year follow up of 107 patients. Gut 1994;35(1):8–14.

    Article  PubMed  CAS  Google Scholar 

  42. Blom D, Peters JH, DeMeester TR, Crookes P, Hagen JA, DeMeester SR, Bremner CG. Physiologic mechanism and preoperative prediction of new-onset dysphagia after laparoscopic Nissen fundoplication. J Gastrointest Surg 2002;6(1):22–7.

    Article  PubMed  Google Scholar 

  43. Fang J, Bjorkman D, Prefundoplication testing: is manometry needed? Am J Gastroenterol 2002;97(4):1056–8.

    PubMed  Google Scholar 

  44. Stein HJ, Barlow AP, DeMeester TR, Hinder RA. Complications of gastroesophageal reflux disease. Role of the lower esophageal sphincter, esophageal acid and acid/alkaline exposure, and duodenogastric reflux. Ann Surg 1992;216(1):35–43.

    Article  PubMed  CAS  Google Scholar 

  45. Fein M, Ritter MP, DeMeester TR, Oberg S, Peters JH, Hagen JA, Bremner CG. Role of the lower esophageal sphincter and hiatal hernia in the pathogenesis of gastroesophageal reflux disease. J Gastrointest Surg 1999;3(4):405–10.

    Article  PubMed  CAS  Google Scholar 

  46. Jones MS, Sloan SS, Rabine JC, Ebert CC, Huang CF, Kahrilas PJ. Hiatal hernia size is the dominant determinant of esophagitis presence and severity in gastroesophageal reflux disease. Am J Gastroenterol 2001;96(6):1711–7.

    Article  PubMed  CAS  Google Scholar 

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  1. K. H. Fuchs

    Present address: Dept. of Surgery, Markus-Krankenhaus, Frankfurter Diakonie-Kliniken, Wilhelm-Epstein-Straße 2, 60431, Frankfurt am Main, Germany

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  1. Dept. of Surgery, Markus-Krankenhaus, Frankfurter Diakonie-Kliniken, Wilhelm-Epstein-Straße 2, 60431, Frankfurt am Main, Germany

    W. Breithaupt

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Fuchs, K.H., Breithaupt, W. Bilan diagnostique du RGO: modalités en vue d’optimiser la chirurgie anti-reflux. Acta Endosc 38, 301–310 (2008). https://doi.org/10.1007/BF02961991

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