The utility of routine pH studies after antireflux surgery

Although pH studies have been shown to be of benefit in the preoperative workup for antireflux surgery, the routine use postoperatively is not well-understood. This study aims to determine the utility of routine pH studies after antireflux surgery.

A prospectively maintained gastroesophageal database was queried for all patients who underwent antireflux surgery, who had a routine postoperative pH evaluation at 1 year. Diagnostic criteria for gastroesophageal reflux disease were defined using the Lyon consensus. Demographic data and perioperative outcomes were analyzed and compared between patients with the χ² test and Spearman correlation coefficients.

Of the 149 patients, 85.7% were off proton pump inhibitor therapy postoperatively. Abnormal pH study results were seen in 7.3% of patients; 81.8% of them had incomplete symptom resolution. Complete symptom resolution was reported by 57 patients (38.2%); 3.5% of them had abnormal pH studies. Incomplete atypical symptom resolution was reported by 64.8%; 9.8% of them had abnormal pH studies. Incomplete typical symptom resolution was reported by 8.3% and all had normal pH studies. Of those with Barrett, 0% had abnormal pH studies. Having an abnormal pH study result was associated with hernia recurrence or undergoing endoscopic dilation postoperatively (r = 0.32, 0.17; P < .0001, P = .03, respectively). Resolution of regurgitation was associated with a normal pH study in 94.4% (P = .01).

Routine pH testing may be helpful in confirming control of esophageal acid exposure in patients with persistent atypical symptoms. Patients with complete symptom resolution and the absence of Barrett may not benefit from routine pH testing postoperatively.