Comparison of Laparoscopic 270° Posterior Partial Fundoplication vs Total Fundoplication for the Treatment of Gastroesophageal Reflux Disease A Randomized Clinical Trial
Question Is partial or total fundoplication superior in laparoscopic antireflux surgery?
Finding In this randomized clinical trial including 456 patients, partial and total fundoplication were equally effective in reducing esophageal acid exposure after 3 years, while mechanical adverse effects were more common after total fundoplication.
Meaning Although partial and total fundoplication could be recommended for treatment of gastroesophageal reflux, partial fundoplication might be superior by inducing less dysphagia.
Importance Restoration of the esophagogastric junction competence is critical for effective long-term treatment of gastroesophageal reflux disease. Surgical repair results in such restoration, but mechanical adverse effects seem unavoidable. Minimizing these adverse effects without jeopardizing reflux control is warranted.
Objective To determine whether partial fundoplication (PF) or total fundoplication (TF) is superior in laparoscopic antireflux surgery.
Design, Setting, and Participants In this double-blind, randomized clinical trial of 1171 patients scheduled for laparoscopic antireflux surgery at a single university-affiliated center between November 19, 2001, and January 24, 2006, 456 patients were randomized and followed up for 5 years. Data were collected from November 2001 to April 2012, and data were analyzed from April 2012 to September 2018.
Interventions A 270° posterior PF or a 360° Nissen TF.
Main Outcomes and Measures Esophageal acid exposure at 3 years after surgery.
Result Of the 456 randomized patients, 268 (58.8%) were male, and the mean (SD) age was 49.0 (11.7) years. A total of 229 patients were randomized to PF, and 227 patients were randomized to TF. At 3 years postoperatively, the median (interquartile range) esophageal acid exposure was reduced from 14.6% (9.8-21.9) to 1.8% (0.7-4.4) after PF and from 16.0% (10.4-22.7) to 2.5% (0.8-6.8) after TF (P = .31). Likewise, reflux symptoms were equally and effectively controlled. Early postoperative dysphagia (6 weeks) was common in both groups but then decreased toward normality. A small but statistically significant difference in favor of PF was noted in the mean (SD) scoring of dysphagia for liquids at 6 weeks (PF, 1.6 [0.9]; TF, 1.9 [1.3]; P = .01) and for solid food at 12 months (PF, 1.3 [1.0]; TF, 1.9 [1.4]; P < .001) and 24 months (PF, 1.3 [0.9]; TF, 1.7 [1.2]; P = .001). Quality of life was reduced before surgery but increased to normal values after surgery and remained so over 5-year follow-up, with no difference between the groups.
Conclusions and Relevance The results from this randomized clinical trial suggest that although PF and TF could be recommended for treatment of gastroesophageal reflux disease, PF might be superior by inducing less dysphagia.
Trial Registration ClinicalTrials.gov identifier: NCT03659487
Germs in Your Gut Are Talking to Your Brain. Scientists Want to Know What They’re Saying. - The New York Times
Source — NY Times Germs in Your Gut Are Talking to Your Brain. Scientists Want to Know What They’re Saying.
The body’s microbial community may influence the brain and behavior, perhaps even playing a role in dementia, autism and other disorders.
In 2014 John Cryan, a professor at University College Cork in Ireland, attended a meeting in California about Alzheimer’s disease. He wasn’t an expert on dementia. Instead, he studied the microbiome, the trillions of microbes inside the healthy human body.
Source — nytimes
Well, yes. Pigeons have excellent vision and, it turns out, can be trained to identify malignant and benign breast tumors pretty much as a radiologist or a pathologist would — by looking at a mammogram or a slide from a biopsy.
Association Between Bariatric Surgery and Macrovascular Disease Outcomes in Patients With Type 2 Diabetes and Severe Obesity
Source — Jama Network
Macrovascular disease is a leading cause of morbidity and mortality for patients with type 2 diabetes, and medical management, including lifestyle changes, may not be successful at lowering risk.
Source — NY Times
Sarcopenia, a decline in skeletal muscle in older people, contributes to loss of independence.
Source — NY Times
Here’s a story from The New York Times that I thought you’d find interesting: Unraveling why tick bites are suddenly causing a strange reaction in some people who eat meat could help scientists better understand how all allergies work.
Source — Lab Blog
Often driven by insurers, delays in approving weight-loss surgery can deter some patients from the pursuit. And waiting longer doesn’t improve safety, a new study says.
Source — NY Times
Are you spending time with the right people for your health and happiness?
While many of us focus primarily on diet and exercise to achieve better health, science suggests that our well-being also is influenced by the company we keep. Researchers have found that certain health behaviors appear to be contagious and that our social networks — in person and online — can influence obesity, anxiety and overall happiness.
Source — The New York Times
Obesity affects 40 percent of adults and 19 percent of children in the United States and accounts for more than $168 billion in health care spending each year. Sugary beverages are thought to be one of the major drivers of the obesity epidemic. These drinks (think soda and sports drinks) are the largest single source of added sugars for Americans and contribute, on average, 145 added calories a day to our diets. For these reasons, reducing sugary beverage consumption has been a significant focus of public health intervention. Most efforts have focused on sodas.
Source — NPR
If you take Prilosec or Zantac for acid reflux, a beta blocker for high blood pressure, or Xanax for anxiety, you may be increasing your risk of depression. More than 200 common medications sold in the U.S. include depression as a potential side effect. Sometimes, the risk stems from taking several drugs at the same time. Now, a new study finds people who take these medicines are, in fact, more likely to be depressed.