Managing reflux after tubular gastric esophageal substitution

Abstract

BACKGROUND

Tubular gastric substitution is a common procedure after esophagectomy, and postoperative reflux symptoms significantly impair the patients' quality of life and nutritional status. Effective long-term nursing strategies are crucial in managing this complication. This study aimed to evaluate the efficacy of a comprehensive follow-up approach.

AIM

To investigate the follow-up nursing interventions and clinical outcomes of reflux following tubular gastric esophageal replacement surgery.

METHODS

A randomized prospective trial was conducted using clinical data from 100 patients with postoperative reflux following tubular gastric esophageal replacement surgery treated at our hospital's Department of Thoracic Surgery between July 2023 and July 2025. Patients were divided into control and study groups based on differing clinical nursing approaches; the control group received routine follow-up care, while the study group underwent comprehensive follow-up care for two months. Pre- and post-intervention comparisons assessed 24-hour reflux frequency, reflux episodes lasting over five minutes, reflux symptom scores, nutritional indicators, quality of life scores, complication rates, and nursing satisfaction.

RESULTS

Pre-intervention, no significant differences existed between groups in 24-hour reflux frequency (study: 9.25 ± 1.33 vs control: 9.30 ± 1.28, P = 0.848) or episodes lasting ≥ 5 minutes (study: 4.83 ± 1.16 vs control: 4.78 ± 1.09, P = 0.825). Post-intervention, both groups showed reductions, with the study group exhibiting significantly lower rates than the control group (24-hour frequency: 2.13 ± 0.35 vs 4.52 ± 1.06, P = 0.000; episodes ≥ 5 minutes: 0.88 ± 0.17 vs 2.03 ± 0.44, P = 0.000). The assessment revealed no significant pre-intervention differences in the scores for heartburn, acid regurgitation, upper abdominal distension, or upper abdominal pain. Post-intervention, all scores decreased, with the study group showing significantly lower scores than the control group (e.g., heartburn: 0.91 ± 0.12 vs 1.46 ± 0.26, P = 0.001). Pre-intervention hemoglobin (Hb), serum albumin, and prealbumin levels were not significantly different between the groups. Post-intervention, all parameters increased, with the study group significantly exceeding the control group (e.g., Hb: 76.05 ± 5.19 g/L vs 62.19 ± 5.07 g/L, P = 0.001). Pre-intervention World Health Organization Quality of Life Brief total scores were comparable between groups (study: 68.15 ± 4.16 vs control: 68.08 ± 4.29, P = 0.931). Post-intervention, both groups demonstrated increased scores, with the study group significantly exceeding the control group (study: 94.02 ± 4.39 vs control: 81.07 ± 5.23, P = 0.000). At the two-month follow-up post-intervention, the complication rate in the study group was 4.0% (2/50), which was significantly lower than the 18.0% (9/50) in the control group [18.0% (9/50); P = 0.001]. Questionnaire surveys revealed a nursing satisfaction rate of 94.0% (47/50) in the study group, which was significantly higher than 78.0% (39/50) in the control group (P = 0.010).

CONCLUSION

Implementing comprehensive follow-up nursing for patients with post-tubular gastric esophageal replacement surgery reflux effectively alleviates reflux symptoms, enhances nutritional status and quality of life, and reduces the incidence of complications, demonstrating significant clinical value.

Keywords: Tubular gastric esophageal replacement surgery; Reflux; Follow-up nursing; Nutritional indicators; Quality of life

Core Tip: Comprehensive follow-up nursing after tubular gastric esophageal replacement surgery can significantly alleviate reflux symptoms, reduce reflux episodes, and improve nutritional indicators and quality of life. Compared to routine care, it also lowers complication rates and increases patient satisfaction, highlighting its clinical value in long-term postoperative management.