Z Gastroenterol 2015; 53 - A55
DOI: 10.1055/s-0035-1551897

6-months follow-up retrospective study of posterior total (NISSEN) fundoplication patients with GERD: Influence of psychiatric co-morbidity and antidepressant co-treatment in therapeutic result outcomes

P Varjú 1, Ö Horváth 2, A Papp 2, J Czimmer 1
  • 1Division of Gastroenterology, First Department of Medicine, Clinical Center, University of Pécs
  • 2Department of Surgery, Clinical Center, University of Pécs

Background: Surgical methods play a significant role in the treatment of gastroesophageal reflux disease (GERD) refractory to conservative therapy. There is no evidence-based consensus on the best choice of technique, posterior total (360o) Nissen fundoplication is the most widely used antireflux surgery technique worldwide. Therapy dependent and refractory GERD patients with psychiatric co-morbidity and/or antidepressant co-treatment araise challange in choice of best treatment methods. Aim of the study was to compare 6-month-results of Nissen fundoplication of psychiatric co-morbidity (PCM, n = 16) and antidepressant co-treatment (ADT, n = 17) as independent risk factors with general population data in our patients (n = 177) between 2011 – 2015. Results: Postoperative improvement of GERD symptoms occured in 86% (symptom-free ratio was 48.6%), in antidepressant treated group 88.2% (and 41%, respectively) and in case of psychiatric co-morbidity 56.2% (and 31.2%, respectively). Reoperation was needed in 2.82% of patiens (none in PCM or ADT group). Postoperative dysphagia occured in 28.8% (50% with PCM, 29% with ADT). Significant (> 10%) weight loss was measured 6 months after surgery in 24.8% (37.5% with PCM, 17.6% with ADT). Generally intervention because of surgery-associated comlication was needed in 10.2% (18.75% with PCM, 5.9% with ADT). Re-use of proton pump inhibitor (PPI) treatment was needed in 32.8% (62.5% with PCM, 35.3% with ADT) 6 month later. Conclusions: Similar to literature data psychiatric co-morbidity in itself worsens therapeutic results of Nissen fundoplication in objectively diagnosed therapy refractory and dependent GERD patients. However antidepressant use in itself does not seem to be a significant risk factor for it, it may decrease weight loss and some complication risk. More randomized data are needed to clear correlations in the matter.