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Titolo:
Psychiatric disorders affect outcomes of antireflux operations for gastroesophageal reflux disease
Autore:
Velanovich, V; Karmy-Jones, R;
Indirizzi:
Henry Ford Hosp, Dept Surg, Div Gen Surg, Detroit, MI 48202 USA Henry FordHosp Detroit MI USA 48202 Div Gen Surg, Detroit, MI 48202 USA
Titolo Testata:
SURGICAL ENDOSCOPY-ULTRASOUND AND INTERVENTIONAL TECHNIQUES
fascicolo: 2, volume: 15, anno: 2001,
pagine: 171 - 175
SICI:
0930-2794(200102)15:2<171:PDAOOA>2.0.ZU;2-6
Fonte:
ISI
Lingua:
ENG
Soggetto:
QUALITY-OF-LIFE; LAPAROSCOPIC NISSEN FUNDOPLICATION; HEALTH SURVEY SF-36; SURGERY; MANAGEMENT; TESTS;
Keywords:
gastroesophageal reflux disease; antireflux surgery; Nissen fundoplication; psychiatric disorders; major depression; anxiety disorders;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
25
Recensione:
Indirizzi per estratti:
Indirizzo: Velanovich, V Henry Ford Hosp, Dept Surg, Div Gen Surg, 2799 W Grand Blvd,Detroit, MI 48202 USA Henry Ford Hosp 2799 W Grand Blvd Detroit MI USA 48202 2 USA
Citazione:
V. Velanovich e R. Karmy-Jones, "Psychiatric disorders affect outcomes of antireflux operations for gastroesophageal reflux disease", SURG ENDOSC, 15(2), 2001, pp. 171-175

Abstract

Background: Most of the information used to determine a patient's candidacy for antireflux surgery has centered on physiologic measurements of esophageal functioning and quantitative assessment of acid reflux. Unfortunately,little attention has been paid to the study of psychosocial factors that could affect outcomes. The purpose of this study was to establish whether concomitant psychiatric disorders might affect the symptomatic outcomes of antireflux surgery. Methods: We retrospectively reviewed a prospectively gathered database of patients with gastroesophageal reflux disease (GERD) who underwent either open or laparoscopic antireflux surgery. A history of a psychiatric disorderwas considered to be present if the patient had been previously diagnosed with a DSM-TV psychiatric diagnosis and was being medically treated for it. Preoperatively, patients were evaluated with the symptom severity questionnaire, the GERD-HRQL (best score 0, worst score 50). Later in the series, patients were also evaluated with the generic quality-of-life questionnaire,the SF-36 (best score 100, worst score 0). After antireflux surgery, patients completed both questionnaires 6 weeks postoperatively. Results: A total of 94 patients underwent antireflux surgery. Seventy-seven of them had laparoscopic antireflux surgery (either Nissen or Toupet fundoplication), and 17 had open antireflux surgery (Nissen, Toupet, Collis-Nissen, or Belsey fundoplications). Nine patients had psychiatric disorders (five major depression, four anxiety disorders). At B-week follow-up, 95.3% of patients without psychiatric disorders were satisfied with surgery, as compared to 11.1% of patients with psychiatric disorders (p < 0.000001), Patients satisfied with surgery had a median SF-36 mental health domain score of 76, as compared to a score of 36 for patients dissatisfied with surgery (p = 0.0002). Patients without psychiatric disorders showed improvement in the median total GERD-HRQL score from 27 preoperatively to 1 postoperatively(p < 0.000001), whereas patients with psychiatric disorders demonstrated less improvement, from 30 preoperatively to 10.5 postoperatively (p = 0.03),Conclusions: Patients with psychiatric disorders are rarely satisfied withthe results of antireflux surgery. Moreover, these patients demonstrated less symptomatic relief than patients without psychiatric disorders. Patients who were dissatisfied with antireflux surgery-even those without psychiatric disorders-had lower scores on the SF-36 mental health domain. These results suggest that even patients who might otherwise be candidates for antireflux surgery may have a poor symptomatic outcome, if they also have low mental health domain scores. Antireflux surgery in patients who suffer from major depression or anxiety disorder should be approached with great trepidation.

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Documento generato il 25/01/20 alle ore 03:26:51