Dysphagia and gastroesophageal reflux disease (GERD) are common in patients with scleroderma. Partial fundoplication is an accepted procedure for GERD; however, it may worsen dysphagia in patients with scleroderma.

A study was conducted to assess the efficacy and acceptability of partial fundoplication to treat refractory GERD in scleroderma patients. Researchers analyzed a database of patients who underwent fundoplication at 14 hospitals from 1991 through 2019. They assessed the perioperative outcomes, reintervention rates, heartburn, dysphagia, and patient satisfaction at 3 months, 1- and 3-years after surgery.

Overall, 17 scleroderma patients were propensity score matched to 526 individuals without scleroderma (controls). All study participants underwent partial fundoplication. Perioperative outcomes, such as complication rate, length of stay, and need for reoperation, were similar between the two groups.

• Both groups had a significant improvement in heartburn at 3 months, 1 year and 3 years after the surgery, in comparison with baseline.
• Surgery was found to be equally effective at controlling heartburn at all follow-up time points in both the groups.
• Patients with scleroderma more frequently had dysphagia to solids, compared to controls at 3 months after the surgery. However, it was not significantly different from controls at 1- and 3-year follow-up.
• Satisfaction scores were high and comparable between the two groups across all follow-up time points. Hundred percent of patients with scleroderma reported that their choice to undergo surgery was correct.

Partial fundoplication is effective at controlling reflux and is tied to a transient period of dysphagia to solids in scleroderma patients.

It is a safe, effective and acceptable approach for patients with scleroderma and medically refractory GERD.

Source: Hii A, Liu DS, Kholmurodova F, et al. Partial Fundoplication is Effective Treatment for Female Patients with Gastroesophageal Reflux and Scleroderma: A Multicenter Comparative Cohort Study. World J Surg. 2022 Jan;46(1):147-153.