The modified AFP score: an attempt to make the results of anti-reflux surgery comparable

Comparison of different strategies in anti-reflux therapy is complicated by wide variations in patient selection and in the criteria employed to assess outcome. A modification of the classification system originally developed by Bancewicz et al. was used to grade a series of 57 patients before and after fundoplication (primary reflux group). An additional group of 39 patients with an unsatisfactory result after previous Nissen fundoplication (failed Nissen group) were assessed before and after reoperation. The classification system used comprises three elements: the A element depicts gastro-oesophageal anatomy based on the findings at endoscopy: the F element codes the amount of acid reflux by means of 24-h intra-oesophageal pH monitoring; and the P element describes mucosal abnormalities. The overall severity was quantified by means of a score on a scale from 0 to 10. The mean preoperative score in the primary reflux group was 5.45 and in the failed Nissen group 7.3. After fundoplication, this was reduced to 1.07 and 1.30, respectively. In general, there was good correlation between the results of the three elements under consideration, pointing to a potential pathophysiological inter-relationship. Marked individual variation did occasionally occur. The AFP system enabled a detailed description of the preoperative and postoperative condition of the patient, and proved easy to use in clinical practice. Its employment is recommended as an objective means of comparing the value of different treatment strategies.