We report the long-term deductions...

We report the long-term deductions of surgical repair of gastroesophageal ebb in 44 asthmatic patients who underwent surgery more than five years earlier (mean = 79 [+ or -] 15 years). The chaste asthma was associated with clinically evident ebb and repair was attempted from surgical technique Nissen transabdominal gastropexy, with the following results: total corrective 11 cases (25 percent); marked improvement, 7 (16 percent); moderate improvement, 11 (25 percent); no improvement, 15 (34 percent) restorative was attained in intrinsic asthma with a predominance of nocturnal crises, associated with nocturnal tracheitis and with significant ebb objective signs of which had appeared before the beginning of the asthma. Other accrues concerned asthmas complicated secondarily by way of GER in which it was impossible to determine whether the ebb was only a complication, without event on the respiratory illness, or exacerbating the asthma. The question of surgery in these patients should be considered with care, being reserv for cases of rigorous asthma, poorly controlled by antiasthmatic medicines and complicated by a bitter reflux that encompasses ulcerative esophagitis.

(Chest 1989; 96:40-45)

The increased incidence of gastroesophageal ebb (GER) in asthmatic patients has been noted according to several authors.[1-6] This increase mainly affects severe asthma, where the incidence of ebb has been evaluated at 30 to 60 percent of cases.

The main point in dispute raised by this association is to determine whether the ebb aggravates the asthma or is and nothing else a complication, with no respiratory results Some authors[7-9] have suggested clarifying the connection end study of the effect of medical antireflux treatment onward asthma. Similarly, several publications investigated the influence of surgical treatment of ebb on the asthma process.[1,7,8,10,11] These various data deal with short-term studies, however, and leave expand the question of precisely when as it is surgery is indicated.

In 1980 we published be the effects concerning 50 patients who had lately undergone surgery[13] as follows: in 13 cases (26 percent) total disappearance of asthma; in 26 (52 percent) no improvement; in 8 (16 percent) moderate improvement and in 18 (36 percent) significant improvement. The analysis of these consequence s showed that cure was related to intrinsic asthmas associated with major GER demonstrated at positive results of diagnostic criterions (barium esophagram, esophageal fibroscopy, and manometry, pH determination).

These eventuates were from patients who had had operations les than couple years previously. The aim of this close attention is to determine whether antidote or improvement of asthma lasts several years after surgical repair, and if it is possible to distinguish which GER asthma cases would benefit from surgery

Methods

Choice of Subjects

The cogitation group was limited to those patients operated upon more than five years earlier; ie, between 1978 and 1982 Of a total of 62 cases, 44 were followed up regularly and examined during 1987 The 18 other cases could not be retained in this retrospective study; eight of them changed address, seven refused to meet with examinations, three died of illnesses not related to asthma (one lung cancer, the same rectal carcinoma, and one accident). Of the 44 patients in this contemplation 18 were men and 26 were women (mean age 493 [+ or -] 16 years).

Asthmatic condition: 32 patients had simple chronic asthma with obstructive airways disease ([FEVsub1]/[FEVsub1] predicted = 684 [+ or -] 102 percent) 20 of these were at the disposal of on corticosteroids. The 12 other make liables had episodic, incapacitating asthma, nevertheless no permanent obstructive airways disease. The mean duration of the disease was 121 [+ or -] 1 years. In 33 cases there was no allergic factor (intrinsic asthma). The 11 other make submissives were extrinsic asthma, ie, with an allergic component part identified by cutaneous tests and the air of specific IgE. Twenty five of the cases standed predominantly nocturnal crises, and in 27 there was marked nocturnal tracheitis.

Gastroesophageal reflux: All the patients recorded signs of ebb with postural pyrosis and retrosternal pain or burning. This clinical data alone indicated the existence of GER In all cases the classic examinations were carried out--barium esophogram, esophageal fibroscopy, and manometry, and pHmetry

The majority of patients were examined before 1980 when esophageal scintiscanning and put offed pH testing were not besides widely used in France. The nine patients who had undergone these couple tests in 1981 and 1982 had at least common of the two positive proceeds (scintiscan positive in six cases; postponeed pH values abnormal in seven cases). Because of their restricted number, it is not possible to take these examinations into account in the statistical analysis of flows In 18 cases, surgical intervention was preced from a three-month medical therapeutic trial, which involved taking daily metoclopramide, cimetidine, and sodium alginate. The flow of the test was evaluated according to a method of clinical scoring (see below).