Recurrent symptoms after fundoplication with a negative pH study--recurrent reflux or functional heartburn?

Area of Science:

• Gastroenterology
• Surgical Outcomes
• Psychiatric Comorbidities

Background:

• Recurrent heartburn post-antireflux surgery affects a subset of patients.
• Over two-thirds of these patients exhibit negative 24-hour pH study results.
• The underlying causes and diagnostic test reliability require further investigation.

Purpose of the Study:

• To investigate functional disorders and cytokine activity in patients with heartburn and negative pH studies.
• To assess the reproducibility of 24-hour pH testing in this patient group.

Main Methods:

• Prospective analysis of patients with recurrent heartburn post-fundoplication.
• Group A: heartburn with negative pH study; Group B: heartburn with positive pH study.
• Utilized questionnaires, blood samples, and repeat pH testing.

Main Results:

• Group A showed significantly higher depression scores than Group B (P=0.03).
• Cytokine levels were comparable between groups.
• Repeat pH testing confirmed negative results in 96% of patients; symptom-reflux correlation was significant (P<0.001).

Conclusions:

• Negative pH studies in recurrent heartburn may indicate functional or psychiatric comorbidities like depression.
• 24-hour pH testing demonstrates excellent reproducibility in patients with recurrent heartburn post-surgery.