Refractory symptoms of gastroesophageal reflux disease after fundoplication may be associated with food intolerance/malabsorption

Objectives

Gastroesophageal reflux disease (GERD) has been identified as the most common gastrointestinal disorder. Despite undergoing fundoplication surgery, a significant number of patients continue to experience symptoms of GERD that are refractory to treatment. This retrospective pilot study reports on the testing of patients with refractory GERD symptoms after fundoplication for food intolerance/malabsorption and gastric Helicobacter pylori (H. pylori).

Methods

In this study, hydrogen (H₂) breath testing was employed to screen for lactose intolerance (LIT) and fructose malabsorption (FM) in 31 patients with refractory GERD after fundoplication. The diagnosis of histamine intolerance (HIT) is determined by a response to a histamine-reduced diet and serum diamine oxidase (DAO) levels. For the detection of H. pylori infection antibodies against H. pylori and for search of celiac disease antibodies to tissue transglutaminase were determined.

Results

Of the patients with refractory GERD after fundoplication, 29 out of 31 (95.5 %) were diagnosed with food intolerance/malabsorption, combinations thereof, and/or H. pylori infection. The utilization of the H₂ breath test resulted in the identification of LIT in 18 out of 31 patients (58.1 %), while 15 out of 31 patients (48.1 %) exhibited low serum DAO, indicative of HIT. FM was identified in 8 out of 31 patients (25.8 %) through the H₂ breath test, and 1 out of 31 patients (3.2 %) showed indications of H. pylori infection.

Conclusion

In the evaluation of patients exhibiting refractory GERD symptoms following fundoplication, it is imperative to consider the potential roles of food intolerance/malabsorption and H. pylori infection as contributing factors. It is recommended that food intolerance and malabsorption be included in the list of potential etiologies of refractory GERD symptoms following fundoplication.