Journal of Gastric Cancer

The Korean Gastric Cancer Association (대한위암학회)
권호 표지
DOI QR코드

DOI QR Code

The Impact of Esophageal Reflux-Induced Symptoms on Quality of Life after Gastrectomy in Patients with Gastric Cancer

  • Im, Min Hye (Gangnam Severance Cancer Hospital) ;
  • Kim, Jong Won (Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Kim, Whan Sik (Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Kim, Jie-Hyun (Division of Gastroenterology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Youn, Young Hoon (Division of Gastroenterology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Park, Hyojin (Division of Gastroenterology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Choi, Seung Ho (Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine)
  • Received : 2014.01.27
  • Accepted : 2014.02.24
  • Published : 2014.03.31
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: To evaluate the prevalence of esophageal reflux-induced symptoms after gastrectomy owing to gastric cancer and assess the relationship between esophageal reflux-induced symptoms and quality of life. Materials and Methods: From January 2012 to May 2012, 332 patients were enrolled in this cross-sectional study. The patients had a history of curative resection for gastric cancer at least 6 months previously without recurrence, other malignancy, or ongoing chemotherapy. Esophageal reflux-induced symptoms were evaluated with the GerdQ questionnaire. The quality of life was evaluated with the European Organization for Research and Treatment QLQ-C30 and STO22 questionnaires. Results: Of the 332 patients, 275 had undergone subtotal gastrectomy and 57 had undergone total gastrectomy. The number of GerdQ(+) patients was 58 (21.1%) after subtotal gastrectomy, and 7 (12.3%) after total gastrectomy (P=0.127). GerdQ(+) patients showed significantly worse scores compared to those for GerdQ(-) patients in nearly all functional and symptom QLQ-C30 scales, with the difference in the mean score of global health status/quality of life and diarrhea symptoms being higher than in the minimal important difference. Additionally, in the QLQ STO22, GerdQ(+) patients had significantly worse scores in every symptom scale. The GerdQ score was negatively correlated with the global quality of life score (r=-0.170, P=0.002). Conclusions: Esophageal reflux-induced symptoms may develop at a similar rate or more frequently after subtotal gastrectomy compared to that after total gastrectomy, and decrease quality of life in gastric cancer patients. To improve quality of life after gastrectomy, new strategies are required to prevent or reduce esophageal reflux.

Keywords

References

  1. Guggenheim DE, Shah MA. Gastric cancer epidemiology and risk factors. J Surg Oncol 2013;107:230-236. https://doi.org/10.1002/jso.23262
  2. Conroy T, Marchal F, Blazeby JM. Quality of life in patients with oesophageal and gastric cancer: an overview. Oncology 2006;70:391-402. https://doi.org/10.1159/000099034
  3. Gisbert JP, Cooper A, Karagiannis D, Hatlebakk J, Agreus L, Jablonowski H, et al. Impact of gastroesophageal reflux disease on patients' daily lives: a European observational study in the primary care setting. Health Qual Life Outcomes 2009;7:60. https://doi.org/10.1186/1477-7525-7-60
  4. Toghanian S, Wahlqvist P, Johnson DA, Bolge SC, Liljas B. The burden of disrupting gastro-oesophageal reflux disease: a database study in US and European cohorts. Clin Drug Investig 2010;30:167-178. https://doi.org/10.2165/11531670-000000000-00000
  5. Inokuchi M, Kojima K, Yamada H, Kato K, Hayashi M, Motoyama K, et al. Long-term outcomes of Roux-en-Y and Billroth-I reconstruction after laparoscopic distal gastrectomy. Gastric Cancer 2013;16:67-73. https://doi.org/10.1007/s10120-012-0154-5
  6. Nunobe S, Okaro A, Sasako M, Saka M, Fukagawa T, Katai H, et al. Billroth 1 versus Roux-en-Y reconstructions: a quality-of-life survey at 5 years. Int J Clin Oncol 2007;12:433-439. https://doi.org/10.1007/s10147-007-0706-6
  7. Lee MS, Ahn SH, Lee JH, Park do J, Lee HJ, Kim HH, et al. What is the best reconstruction method after distal gastrectomy for gastric cancer? Surg Endosc 2012;26:1539-1547. https://doi.org/10.1007/s00464-011-2064-8
  8. Matei D, Dadu R, Prundus R, Danci I, Ciobanu L, Mocan T, et al. Alkaline reflux esophagitis in patients with total gastrectomy and Roux en Y esojejunostomy. J Gastrointestin Liver Dis 2010;19:247-252.
  9. Kim JW, Yoon H, Kong SH, Kim JS, Paeng JC, Lee HJ, et al. Analysis of esophageal reflux after proximal gastrectomy measured by wireless ambulatory 24-hr esophageal pH monitoring and TC-99m diisopropyliminodiacetic acid (DISIDA) scan. J Surg Oncol 2010;101:626-633. https://doi.org/10.1002/jso.21560
  10. Enjoji M, Yamada H, Kojima K, Inokuchi M, Kato K, Kawano T, et al. Scoring system for evaluating functional disorders following laparoscopy-assisted distal gastrectomy. J Surg Res 2010;164:e229-e233. https://doi.org/10.1016/j.jss.2010.08.041
  11. Kim JH, Park H, Lee YC; MIGHT study group. Is minimal change esophagitis really part of the spectrum of endoscopic findings of gastroesophageal reflux disease? A prospective, multicenter study. Endoscopy 2011;43:190-195. https://doi.org/10.1055/s-0030-1256101
  12. Shaw MJ, Talley NJ, Beebe TJ, Rockwood T, Carlsson R, Adlis S, et al. Initial validation of a diagnostic questionnaire for gastroesophageal reflux disease. Am J Gastroenterol 2001;96:52-57. https://doi.org/10.1111/j.1572-0241.2001.03451.x
  13. Jones R, Coyne K, Wiklund I. The gastro-oesophageal reflux disease impact scale: a patient management tool for primary care. Aliment Pharmacol Ther 2007;25:1451-1459. https://doi.org/10.1111/j.1365-2036.2007.03343.x
  14. Revicki DA, Wood M, Wiklund I, Crawley J. Reliability and validity of the Gastrointestinal Symptom Rating Scale in patients with gastroesophageal reflux disease. Qual Life Res 1998;7:75-83.
  15. Jones R, Junghard O, Dent J, Vakil N, Halling K, Wernersson B, et al. Development of the GerdQ, a tool for the diagnosis and management of gastro-oesophageal reflux disease in primary care. Aliment Pharmacol Ther 2009;30:1030-1038. https://doi.org/10.1111/j.1365-2036.2009.04142.x
  16. Ponce J, Garrigues V, Agreus L, Tabaglio E, Gschwantler M, Guallar E, et al. Structured management strategy based on the Gastro-oesophageal Reflux Disease (GERD) Questionnaire (GerdQ) vs. usual primary care for GERD: pooled analysis of five cluster-randomised European studies. Int J Clin Pract 2012;66:897-905. https://doi.org/10.1111/j.1742-1241.2012.02992.x
  17. Dent J, Vakil N, Jones R, Bytzer P, Schoning U, Halling K, et al. Accuracy of the diagnosis of GORD by questionnaire, physicians and a trial of proton pump inhibitor treatment: the Diamond Study. Gut 2010;59:714-721. https://doi.org/10.1136/gut.2009.200063
  18. Huang CC, Lien HH, Sung YC, Liu HT, Chie WC. Quality of life of patients with gastric cancer in Taiwan: validation and clinical application of the Taiwan Chinese version of the EORTC QLQ-C30 and EORTC QLQ-STO22. Psychooncology 2007;16:945-949. https://doi.org/10.1002/pon.1158
  19. Shaw M, Dent J, Beebe T, Junghard O, Wiklund I, Lind T, et al. The Reflux Disease Questionnaire: a measure for assessment of treatment response in clinical trials. Health Qual Life Outcome 2008;6:31. https://doi.org/10.1186/1477-7525-6-31
  20. Blazeby JM, Conroy T, Bottomley A, Vickery C, Arraras J, Sezer O, et al; European Organisation for Research and Treatment of Cancer Gastrointestinal and Quality of Life Groups. Clinical and psychometric validation of a questionnaire module, the EORTC QLQ-STO 22, to assess quality of life in patients with gastric cancer. Eur J Cancer 2004;40:2260-2268. https://doi.org/10.1016/j.ejca.2004.05.023
  21. Blazeby JM, Currie E, Zee BC, Chie WC, Poon RT, Garden OJ; EORTC Quality of Life Group. Development of a questionnaire module to supplement the EORTC QLQ-C30 to assess quality of life in patients with hepatocellular carcinoma, the EORTC QLQ-HCC18. Eur J Cancer 2004;40:2439-2444. https://doi.org/10.1016/j.ejca.2004.06.033
  22. Yun YH, Park YS, Lee ES, Bang SM, Heo DS, Park SY, et al. Validation of the Korean version of the EORTC QLQ-C30. Qual Life Res 2004;13:863-868. https://doi.org/10.1023/B:QURE.0000021692.81214.70
  23. Kong H, Kwon OK, Yu W. Changes of quality of life after gastric cancer surgery. J Gastric Cancer 2012;12:194-200. https://doi.org/10.5230/jgc.2012.12.3.194
  24. Fayer PM, Aaronson NK, Bjordal K, Groenvold M, Curran D, Bottomley A, et al. EORTC QLQ-C30 scoring manual. 3rd ed. Brussels: European Organisation for Research and Treatment of Cancer, 2001.
  25. Cocks K, King MT, Velikova G, Martyn St-James M, Fayers PM, Brown JM. Evidence-based guidelines for determination of sample size and interpretation of the European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30. J Clin Oncol 2011;29:89-96. https://doi.org/10.1200/JCO.2010.28.0107
  26. King MT. A point of minimal important difference (MID): a critique of terminology and methods. Expert Rev Pharmacoecon Outcomes Res 2011;11:171-184. https://doi.org/10.1586/erp.11.9
  27. Cohen J. Statistical power analysis for the behavioral sciences. New York: Academic Press, 1977.
  28. Copay AG, Subach BR, Glassman SD, Polly DW Jr, Schuler TC. Understanding the minimum clinically important difference: a review of concepts and methods. Spine J 2007;7:541-546. https://doi.org/10.1016/j.spinee.2007.01.008
  29. Dent J, El-Serag HB, Wallander MA, Johansson S. Epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut 2005;54:710-717. https://doi.org/10.1136/gut.2004.051821
  30. El-Serag HB. Epidemiology of non-erosive reflux disease. Digestion 2008;78 Suppl 1:6-10. https://doi.org/10.1159/000151249
  31. Lehnert T, Buhl K. Techniques of reconstruction after total gastrectomy for cancer. Br J Surg 2004;91:528-539. https://doi.org/10.1002/bjs.4512
  32. Katsoulis IE, Robotis JF, Kouraklis G, Yannopoulos PA. What is the difference between proximal and total gastrectomy regarding postoperative bile reflux into the oesophagus? Dig Surg 2006;23:325-330. https://doi.org/10.1159/000097948
  33. Hsu CP, Chen CY, Hsieh YH, Hsia JY, Shai SE, Kao CH. Esophageal reflux after total or proximal gastrectomy in patients with adenocarcinoma of the gastric cardia. Am J Gastroenterol 1997;92:1347-1350.
  34. Tokunaga M, Hiki N, Ohyama S, Nunobe S, Miki A, Fukunaga T, et al. Effects of reconstruction methods on a patient's quality of life after a proximal gastrectomy: subjective symptoms evaluation using questionnaire survey. Langenbecks Arch Surg 2009;394:637-641. https://doi.org/10.1007/s00423-008-0442-z
  35. Ichikawa D, Komatsu S, Okamoto K, Shiozaki A, Fujiwara H, Otsuji E. Evaluation of symptoms related to reflux esophagitis in patients with esophagogastrostomy after proximal gastrectomy. Langenbecks Arch Surg 2013;398:697-701. https://doi.org/10.1007/s00423-012-0921-0
  36. Johnson DA, Fennerty MB. Heartburn severity underestimates erosive esophagitis severity in elderly patients with gastroesophageal reflux disease. Gastroenterology 2004;126:660-664. https://doi.org/10.1053/j.gastro.2003.12.001
  37. Iida F, Ishizaka K, Sugenoya A. Lower esophageal sphincter pressure after subtotal gastrectomy and postoperative reflux esophagitis. Hepatogastroenterology 1994;41:581-584.
  38. Fujiwara Y, Nakao K, Inoue T, Koishi K, Nishio Y, Yagyu R, et al. Clinical significance of hiatal hernia in the development of gastroesophageal reflux after distal gastrectomy for cancer of the stomach. J Gastroenterol Hepatol 2006;21:1103-1107. https://doi.org/10.1111/j.1440-1746.2006.04135.x
  39. Crookes PF. Gastroesophageal reflux after partial gastrectomy. Am J Gastroenterol 1998;93:3-4. https://doi.org/10.1111/j.1572-0241.1998.003_c.x
  40. Fujiwara Y, Nakagawa K, Kusunoki M, Tanaka T, Yamamura T, Utsunomiya J. Gastroesophageal reflux after distal gastrectomy: possible significance of the angle of His. Am J Gastroenterol 1998;93:11-15. https://doi.org/10.1111/j.1572-0241.1998.011_c.x
  41. Windsor CW. Gastro-oesophageal reflux after partial gastrectomy. Br Med J 1964;2:1233-1234. https://doi.org/10.1136/bmj.2.5419.1233
  42. Gutschow C, Collard JM, Romagnoli R, Salizzoni M, Holscher A. Denervated stomach as an esophageal substitute recovers intraluminal acidity with time. Ann Surg 2001;233:509-514. https://doi.org/10.1097/00000658-200104000-00005
  43. Shibata Y. Effect of semifundoplication with subtotal gastrectomy for prevention of postoperative gastroesophageal reflux. J Am Coll Surg 2004;198:212-217. https://doi.org/10.1016/j.jamcollsurg.2003.10.010
  44. Montesani C, D'Amato A, Santella S, Pronio A, Giovannini C, Cristaldi M, et al. Billroth I versus Billroth II versus Roux-en-Y after subtotal gastrectomy. Prospective [correction of prespective] randomized study. Hepatogastroenterology 2002;49:1469-1473.

Cited by

  1. Relationships between gastrointestinal symptoms, uncertainty, and perceived recovery in patients with gastric cancer after gastrectomy vol.18, pp.1, 2014, https://doi.org/10.1111/nhs.12219
  2. Laryngectomy in a patient with severe pneumonia caused by dysphagia after pulmonary resection for primary lung cancer complicated with GERD following distal gastrectomy: A case report vol.30, pp.5, 2014, https://doi.org/10.2995/jacsurg.30.598
  3. Acid Secretion and Its Relationship to Esophageal Reflux Symptom in Patients with Subtotal Gastrectomy vol.63, pp.3, 2014, https://doi.org/10.1007/s10620-018-4923-9
  4. Long noncoding RNA LBX2-AS1-modulated miR-4766-5p regulates gastric cancer development through targeting CXCL5 vol.20, pp.1, 2014, https://doi.org/10.1186/s12935-020-01579-z
  5. Defecation disorders are crucial sequelae that impairs the quality of life of patients after conventional gastrectomy vol.13, pp.11, 2021, https://doi.org/10.4240/wjgs.v13.i11.1484