GASTRO‐OESOPHAGEAL REFLUX AND RESPIRATORY DISEASE: THE PLACE OF THE SURGEON*

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Abstract
The association between gastro-oesophageal reflux (GER) and respiratory disease is well studied and established. A causal relationship, except in the case of clear cut aspiration, continues to elude proof but is supported by an increasing body of clinical experience. Barium oesophagram is the logical first test to demonstrate reflux, to rule out distal obstruction, and to provide good imaging of the oesophagus. Extended (24 h) oesophageal pH monitoring has proven to be the most reliable test in our hands for the identification of abnormal reflux. The false negative rate with this test was 12%, and false positives were seen only 6% of the time. Radionuclide scintigraphy offers the theoretical possibility for absolute correlation between reflux and aspiration, but in practice the results have been disappointing. Where other treatment measures have failed and where objective tests and clinical evidence point to the probability that respiratory disease is reflux-induced, anti reflux surgery is justified and most often strikingly successful. A Nissen fundoplication with a loose wrap and a short cuff is still the standard treatment for antireflux surgery. Long term follow-up suggests the benefits of antireflux surgery outweigh the occasional complications and side effects where operation is performed to control otherwise intractable reflux-associated symptoms.