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. 2004 Apr;96(4):535–541.

Comparison of antireflux surgery among ethnicity.

Benjamin Haithcock 1, Vic Velanovich 1
PMCID: PMC2594992  PMID: 15101673

Abstract

African Americans appear less likely than caucasians to undergo surgery for gastroesophageal reflux disease (GERD). When they do, they appear to have higher conversion and complication rates. Nevertheless, satisfaction with surgery is similar to caucasians. BACKGROUND: There is little information comparing the prevalence and treatment of GERD in various ethnic populations. The purpose of this study was to examine the variations in outcomes between caucasians and African Americans undergoing antireflux surgery. METHODS: The records of all patients who underwent antireflux surgery for GERD or paraesophageal hernia by a single surgeon from January 1997 through December 2001 were reviewed for preoperative and postoperative symptoms, complications, and postoperative satisfaction with surgery. RESULTS: Of the 204 procedures performed, 198 patients were either African American (24) or caucasian (174). Of the 18 African Americans undergoing laparoscopic antireflux surgery (LARS), five were converted to open and four had grade-1 or -2 complications. Of the 160 caucasians undergoing LARS, 27 were converted, and 17 had grade-1, -2, or -3 complications. African-American females had a heavier weight (222 lbs. versus 175 lbs., p<0.05) and conversion rate (55% versus 18%, p<0.05), compared to caucasian females. Satisfaction rates for African Americans were 88%, compared to 82% for caucasians. CONCLUSION: This study demonstrated significant differences between conversion rates in African Americans and caucasians with respects to frequency of surgery for GERD and conversion rates for LARS. Nevertheless, African Americans appear more satisfied with their surgical outcome. Further research is needed to determine whether African Americans truly have a lower incidence of GERD or if bias exists in referral patterns or cultural attitudes.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Armstrong D. Reflux disease and Barrett's oesophagus. Endoscopy. 1994 Jan;26(1):9–19. doi: 10.1055/s-2007-1005804. [DOI] [PubMed] [Google Scholar]
  2. Campos G. M., Peters J. H., DeMeester T. R., Oberg S., Crookes P. F., Tan S., DeMeester S. R., Hagen J. A., Bremner C. G. Multivariate analysis of factors predicting outcome after laparoscopic Nissen fundoplication. J Gastrointest Surg. 1999 May-Jun;3(3):292–300. doi: 10.1016/s1091-255x(99)80071-7. [DOI] [PubMed] [Google Scholar]
  3. Clavien P. A., Sanabria J. R., Strasberg S. M. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery. 1992 May;111(5):518–526. [PubMed] [Google Scholar]
  4. Earle Craig C., Neumann Peter J., Gelber Richard D., Weinstein Milton C., Weeks Jane C. Impact of referral patterns on the use of chemotherapy for lung cancer. J Clin Oncol. 2002 Apr 1;20(7):1786–1792. doi: 10.1200/JCO.2002.07.142. [DOI] [PubMed] [Google Scholar]
  5. Fichtenbaum R., Gyimah-Brempong K. The effects of race on the use of physician's services. Int J Health Serv. 1997;27(1):139–156. doi: 10.2190/GQHJ-CUQT-N63H-CG0H. [DOI] [PubMed] [Google Scholar]
  6. Fiscella Kevin, Franks Peter, Doescher Mark P., Saver Barry G. Disparities in health care by race, ethnicity, and language among the insured: findings from a national sample. Med Care. 2002 Jan;40(1):52–59. doi: 10.1097/00005650-200201000-00007. [DOI] [PubMed] [Google Scholar]
  7. Fraser J., Watson D. I., O'Boyle C. J., Jamieson G. G. Obesity and its effect on outcome of laparoscopic Nissen fundoplication. Dis Esophagus. 2001;14(1):50–53. doi: 10.1111/j.1442-2050.2001.00157.x. [DOI] [PubMed] [Google Scholar]
  8. Freiman M. P. The demand for healthcare among racial/ethnic subpopulations. Health Serv Res. 1998 Oct;33(4 Pt 1):867–890. [PMC free article] [PubMed] [Google Scholar]
  9. Hargraves J. L., Cunningham P. J., Hughes R. G. Racial and ethnic differences in access to medical care in managed care plans. Health Serv Res. 2001 Oct;36(5):853–868. [PMC free article] [PubMed] [Google Scholar]
  10. Kahrilas P. J. Gastroesophageal reflux disease. JAMA. 1996 Sep 25;276(12):983–988. [PubMed] [Google Scholar]
  11. Malaty H. M., Evans D. G., Evans D. J., Jr, Graham D. Y. Helicobacter pylori in Hispanics: comparison with blacks and whites of similar age and socioeconomic class. Gastroenterology. 1992 Sep;103(3):813–816. doi: 10.1016/0016-5085(92)90011-m. [DOI] [PubMed] [Google Scholar]
  12. Mukamel D. B., Murthy A. S., Weimer D. L. Racial differences in access to high-quality cardiac surgeons. Am J Public Health. 2000 Nov;90(11):1774–1777. doi: 10.2105/ajph.90.11.1774. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Nebel O. T., Fornes M. F., Castell D. O. Symptomatic gastroesophageal reflux: incidence and precipitating factors. Am J Dig Dis. 1976 Nov;21(11):953–956. doi: 10.1007/BF01071906. [DOI] [PubMed] [Google Scholar]
  14. Perez A. R., Moncure A. C., Rattner D. W. Obesity adversely affects the outcome of antireflux operations. Surg Endosc. 2001 Jun 12;15(9):986–989. doi: 10.1007/s004640000392. [DOI] [PubMed] [Google Scholar]
  15. Rayment S. A., Liu B., Offner G. D., Oppenheim F. G., Troxler R. F. Salivary mucin: a factor in the lower prevalence of gastroesophageal reflux disease in African-Americans? Am J Gastroenterol. 2000 Nov;95(11):3064–3070. doi: 10.1111/j.1572-0241.2000.03253.x. [DOI] [PubMed] [Google Scholar]
  16. Vakil N. B. Review article: gastro-oesophageal reflux disease and Helicobacter pylori infection. Aliment Pharmacol Ther. 2002 Mar;16 (Suppl 1):47–51. doi: 10.1046/j.1365-2036.2002.0160s1047.x. [DOI] [PubMed] [Google Scholar]
  17. Velanovich V. Comparison of symptomatic and quality of life outcomes of laparoscopic versus open antireflux surgery. Surgery. 1999 Oct;126(4):782–789. [PubMed] [Google Scholar]
  18. Velanovich V., Yood M. U., Bawle U., Nathanson S. D., Strand V. F., Talpos G. B., Szymanski W., Lewis F. R., Jr Racial differences in the presentation and surgical management of breast cancer. Surgery. 1999 Apr;125(4):375–379. [PubMed] [Google Scholar]
  19. Wu J. C. Y., Chan F. K. L., Wong S. K. H., Lee Y. T., Leung W. K., Sung J. J. Y. Effect of Helicobacter pylori eradication on oesophageal acid exposure in patients with reflux oesophagitis. Aliment Pharmacol Ther. 2002 Mar;16(3):545–552. doi: 10.1046/j.1365-2036.2002.01189.x. [DOI] [PubMed] [Google Scholar]

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