Patients' experiences of gastro-oesophageal reflux after oesophagectomy for cancer - a qualitative study

Gastroesophageal reflux is common in patients with oesophageal cancer, both before and after surgery with oesophagectomy. Oesophagectomy introduces anatomical changes that alter reflux characteristics, yet most evidence on postoperative reflux comes from objective measures or patient-reported questionnaires rather than from patients' own narratives. The differences between postoperative reflux symptoms and preoperative patterns remain unclear. Therefore, this study aimed to explore the subjective experience of gastroesophageal reflux after oesophagectomy.

This qualitative descriptive study was based on individual interviews with 29 patients who underwent treatment for oesophageal cancer in Sweden between 2021 and 2023. Participants were identified through the Swedish National Quality Register for Oesophageal and Gastric Cancer. Semi-structured interviews were conducted between January and February 2025, and the data were analysed using an inductive content analysis approach described by Elo and Kyngäs.

The analysis resulted in the following three categories: characterisation of postoperative reflux, comparison of preoperative and postoperative reflux, and management strategies before and after oesophageal cancer surgery. Participants reported that postoperative reflux symptoms differed markedly from preoperative reflux symptoms, being less frequent but more severe, painful, and predominantly nocturnal. Unlike preoperative reflux, which was often stress-related and characterised by a mild sour taste, postoperative episodes involved intense burning sensations, unpleasant taste, and oesophageal pain.

This study demonstrates that postoperative reflux differs from preoperative reflux not only in symptom type and intensity but also in patients' interpretations and coping strategies. These findings indicate that postoperative reflux requires distinct clinical attention, particularly regarding nocturnal symptoms that are highly intrusive and difficult to manage with medication alone. The study highlights the importance of proactive patient education about altered symptom profiles and the development of tailored postoperative management strategies. Incorporating these insights into follow-up care may improve patients' ability to recognise, interpret, and manage reflux symptoms after oesophagectomy.