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.

Key Words: 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.

INTRODUCTION

Esophageal cancer is a common malignant tumor of the digestive system, presenting with high incidence and mortality rates that pose a significant threat to human health and life[1]. Currently, radical resection is the primary clinical treatment, particularly for early and mid-stage esophageal cancers. Digestive tract reconstruction is required after esophageal resection. Most patients undergo tubular gastric replacement of the esophagus. However, patients experience varying degrees of gastroesophageal reflux postoperatively, which not only exacerbates patient suffering but may also lead to abnormal nutritional indicators and reduced quality of life[2,3]. Consequently, effective prevention and alleviation of postoperative gastroesophageal reflux has become a critical focus in esophageal surgery. Practice demonstrates that follow-up nursing enables the timely detection and management of reflux symptoms, positively influencing patient outcomes. However, postoperative reflux follow-up care for tubular gastric esophageal replacement surgery predominantly focuses on the immediate postoperative period, with insufficient long-term follow-up, particularly for discharged patients[4,5]. Consequently, there is a need to provide continuous and comprehensive follow-up nursing care. Comprehensive follow-up care facilitates effective self-management by regularly monitoring reflux symptoms, nutritional indicators, and quality of life while delivering personalized health education and lifestyle guidance[6]. This retrospective study analyzed and evaluated the feasibility and efficacy of implementing comprehensive follow-up care for patients with reflux after tubular gastric replacement surgery, thereby providing evidence for clinical practice.

MATERIALS AND METHODS

Study population

This retrospective study was conducted by collecting and collating clinical data from 100 patients with post-tubular gastric esophageal replacement reflux diagnosed and treated in our hospital’s Department of Thoracic Surgery between July 2023 and July 2025. Written informed consent was obtained from all the patients. The study complied with the requirements of the Declaration of Helsinki.

Inclusion criteria: (1) History of tubular gastric esophageal replacement surgery; (2) Postoperative diagnosis of gastroesophageal reflux confirmed through symptoms and examinations[7]; (3) Age 18-75 years; (4) No cardiac, hepatic, or renal insufficiency; (5) Normal consciousness and cognition and the ability to cooperate with nursing care; and (6) Complete clinical records.

Exclusion criteria: (1) Presence of complications such as esophageal fistula or infection; (2) Poor postoperative nutritional status; (3) Communication or cognitive impairment; and (4) Inability to complete the scheduled follow-up.

Methodology

The participants were divided into two groups based on the clinical nursing approach, with 50 patients per group.

Control group: This group received routine follow-up care with one post-discharge visit per week. Prior to discharge, the nursing staff provided home care instructions and distributed health education booklets for review. After discharge, the staff addressed patients’ queries and guided them in mastering self-care skills. Appropriate dietary plans were formulated based on individual patient conditions and advice regarding small, frequent meals to prevent excessive fullness. Daily meals were focused on easily digestible and bland foods. Additionally, patients were instructed to adhere strictly to prescribed medication regimens, including acid-suppressing drugs and gastric mucosal protectors such as proton pump inhibitors (PPI).

Study group: This group received comprehensive follow-up care delivered by a dedicated follow-up nursing team as detailed below: (1) Establishment of the nursing team: A nursing team comprising the ward head nurse, nurses, doctors, and dietitians was formed. The head nurse served as a team leader, coordinating follow-up care matters, liaising with and integrating internal and external nursing resources, and providing the necessary professional guidance. Dietitians and clinicians were responsible for assessing and analyzing patients' reflux conditions and guiding nursing staff in developing appropriate comprehensive care plans. Nurses undertook patient condition assessments and implemented care protocols; (2) Follow-up care components: Follow-up care included six components; health education, dietary management, lifestyle interventions, psychological support, medication guidance, and follow-up feedback; (3) Health education. During follow-up appointments, educational videos were distributed via WeChat and other platforms to thoroughly explain the common causes of reflux following tubular gastrectomy with esophageal replacement. Patients and their families were instructed so they could recognize typical reflux symptoms, such as acid regurgitation and heartburn, and to be informed of potential triggers for symptom exacerbation, including the consumption of irritant foods and bending over, to enhance their understanding of reflux; (4) Dietary management. Daily nutritional requirements for energy, protein, vitamins, and minerals were assessed based on patient age, sex, weight, physical activity level, and postoperative recovery. Dietary plans that met nutritional needs while minimizing reflux symptoms were created. In addition to avoiding high-fat, high-fiber, PPI and irritant foods, patients were advised to consume easily digestible and nutrient-dense options, such as lean meats, fish, eggs, tofu products, puréed vegetables, and puréed fruits. Eating smaller, more frequent meals, was recommended, limiting each portion to 300-500 mL, to prevent excessive gastric pressure from a large intake. Maintaining a relaxed state of mind during meals and avoiding talking while eating was advised to minimize air swallowing. Patients were advised to refrain from lying flat immediately after eating; instead, it was suggested they remain seated or stroll for 1-2 hours to aid digestion and gastric emptying. Emphasis was placed on the importance of thorough chewing, advising patients to chew each mouthful 20-30 times to ensure adequate mixing with saliva and facilitating digestion and absorption while reducing the gastric burden; (5) Lifestyle interventions. Patients were advised to elevate their bedheads by 15-20 cm while sleeping. They were instructed to avoid prone sleeping positions, as these increase intragastric pressure and exacerbate reflux symptoms. Lateral or supine sleeping positions were recommended, with pillows placed on either side of the body for comfort. Patients were instructed to engage in moderate aerobic exercise, such as brisk walking, yoga, swimming, or cycling, approximately three times weekly for 30 minutes per session, adjusting the intensity to individual tolerance; (6) Psychological support. At each follow-up appointment, standardized psychological assessment tools were employed to screen the patients' emotional states, enabling timely identification of adverse psychological reactions. For patients exhibiting such reactions, prompt psychological counselling was provided. Techniques such as active listening, empathy, and explanatory dialogues were used to alleviate psychological stress and facilitate emotional adjustment. Patients were encouraged to articulate their feelings and concerns, and received affirmative feedback and support; (7) Medication guidance. Patient were advised to maintain strict adherence to prescribed acid-suppressing medications (e.g., PPIs) that inhibit gastric acid secretion and alleviate gastroesophageal reflux symptoms. The concurrent use of other agents, such as mucosal protectants, was explained. The mechanism of action and necessity of such medications was outlined to patients, and they were instructed on the correct administration methods and precautions; (8) Follow-up feedback. After each follow-up visit, changes in patient condition, nursing interventions, and outcomes were documented. The effectiveness of follow-up care was periodically evaluated, summarizing lessons learned, and continually refining follow-up nursing plans; and (9) Follow-up care approach: Initial follow-up was conducted within one week of discharge, followed by weekly appointments lasting approximately 15 minutes to assess recovery progress and any discomfort. Monthly outpatient follow-ups were conducted for two consecutive months, during which patients were thoroughly questioned regarding the frequency, severity, and duration of reflux symptoms, such as acid regurgitation, heartburn, chest pain, coughing, and throat discomfort, with changes in symptoms recorded.

Observation indicators

Reflux occurrence: The patient's 24-hour reflux frequency and the frequency of reflux episodes lasting over 5 minutes were recorded before and after the nursing intervention.

Reflux symptom score: The Gastroesophageal Reflux Disease (GERD) Symptom Score questionnaire was administered before and after nursing interventions to assess four primary symptoms: Heartburn, acid regurgitation, upper abdominal bloating, and upper abdominal pain. This scale scores each symptom based on severity and frequency: Moderate (noticeable symptoms that draw attention but remain tolerable) or occurring 2-4 days per week: 2 points; severe (symptoms significantly impacting daily life) or occurring ≥ 5 days per week: 3 points. The sum of the scores for each symptom constitutes the total score, which ranges from 0 to 12 points. Higher scores indicated more severe reflux symptoms[8]. This scale is widely used in patients with gastrointestinal disorders, and its content validity has been recognized by experts. In the study population, the scale demonstrated good internal consistency with a Cronbach's alpha coefficient of 0.872.

Nutritional indicators: Hemoglobin (Hb), serum albumin (ALB), and prealbumin (PA) levels were measured via peripheral venous blood sampling before and after the intervention.

Quality of life: The World Health Organization Quality of Life Brief (WHOQOL-BREF) was used for pre- and post-intervention assessments. This scale, developed by the World Health Organization, is a cross-cultural, multilingual, and universally applicable instrument with strong international comparability. It has undergone localization and validation of its reliability and validity in the Chinese population. It comprises four dimensions: Physical health (seven items), psychological health (six items), social relationships (three items), and environmental domain (eight items), totaling 26 items. Each item is assessed on a 1-5 point Likert scale. Scores from each domain are converted to a percentage scale (0-100) via a specific formula. The total scale score is the average of the domain scores, with higher scores indicating a better quality of life[9]. This scale has been widely used to assess the quality of life of patients with chronic diseases and cancer. In this study, the scale demonstrated excellent internal consistency reliability, with a Cronbach's α coefficient of 0.905.

Complication incidence: The number of post-intervention complications, including upper respiratory tract infections, pleural effusions, and anastomotic fistulas, was recorded.

Nursing satisfaction: A self-designed questionnaire was used to gauge patient satisfaction with nursing care encompassing dimensions such as health education, follow-up guidance, nursing skills, and professional attitudes. The total score was 100 points, with ≥ 90 points indicating very satisfied, 80-89 points indicating satisfied, 70-79 points indicating fair, and < 70 points indicating dissatisfaction. Overall satisfaction was defined as the sum of the very satisfied and satisfied responses.

Statistical analysis

The clinical data were processed using SPSS version 25.0 (IBM Corp., Armonk, NY, United States). Count data are presented as n (%). Intergroup comparisons were performed using the χ² test. Continuous data are expressed as mean ± SD and analyzed using t-tests. Statistical significance was set at P < 0.05.

RESULTS

Study participant characteristics

The control group comprised 27 males and 23 females. Their ages ranged from 31-72 years (mean 49.33 ± 4.17 years) and reflux disease duration was 1-4 months (mean 2.18 ± 0.41 months). Twenty-two had junior secondary education or below, 14 had senior secondary education, and 14 had tertiary education or above. The study group comprised 28 males, and 22 females with age range 34-71 years, mean (49.21 ± 4.32) years. Their reflux duration was 2-4 months, mean (2.33 ± 0.52) months. Twenty had junior secondary school education or below, while 17 had senior secondary school education and 13 had college education or above. No significant differences were observed between the two groups in terms of clinical characteristics, indicating good comparability.

Comparison of reflux occurrence between groups before and after nursing intervention

Prior to the nursing intervention, no significant differences were observed between the groups in 24-hour reflux frequency or duration of reflux episodes exceeding 5 minutes. Post-intervention, the study group exhibited lower scores than the control group (P < 0.05) (Table 1).

Table 1 Comparison of reflux incidence between groups before and after nursing care, mean ± SD.

Group	n	24-hour reflux frequency		Reflux episodes > 5 minutes
		Before	After	Before	After
Study	50	9.25 ± 1.33	2.13 ± 0.35a	4.83 ± 1.16	0.88 ± 0.17a
Control	50	9.30 ± 1.28	4.52 ± 1.06a	4.78 ± 1.09	2.03 ± 0.44a
t		0.191	15.140	0.221	13.887
P value		0.848	0.000	0.825	0.000

^aP < 0.05 vs same group before and after nursing.

Continuous data were compared using independent samples student's t-test.

Comparison of reflux symptom scores between groups before and after nursing intervention

The assessment revealed no significant differences in symptom scores for heartburn, acid regurgitation, upper abdominal distension, or upper abdominal pain between the groups before the intervention. Post-intervention, the study group exhibited lower scores than the control group (P < 0.05) (Table 2).

Table 2 Comparison of reflux symptom scores between groups before and after nursing care, mean ± SD.

Group	n	Heartburn		Acid regurgitation		Upper abdominal distension		Upper abdominal pain
		Before	After	Before	After	Before	After	Before	After
Study	50	2.37 ± 0.28	0.91 ± 0.12a	2.53 ± 0.33	0.97 ± 0.21a	2.27 ± 0.22	1.01 ± 0.14a	1.83 ± 0.46	0.86 ± 0.11a
Control	50	2.29 ± 0.31	1.46 ± 0.26a	2.51 ± 0.37	1.69 ± 0.34a	2.30 ± 0.25	1.62 ± 0.21a	1.84 ± 0.48	1.03 ± 0.18a
t		1.352	13.578	0.291	12.742	0.641	17.089	0.110	5.701
P value		0.180	0.001	0.775	0.000	0.524	0.000	0.915	0.000

^aP < 0.05 vs same group before and after nursing.

Continuous data were compared using independent samples student's t-test. Interpretation of the Reflux Symptom Scale Score: The total score ranges from 0 to 12, with higher scores indicating more severe and frequent symptoms. Scores were interpreted as follows: 0, asymptomatic; 1-4 = mild; 5-8 = moderate; 9-12 = severe.

Comparison of nutritional indicators between groups before and after intervention

Preintervention measurements showed no significant differences in Hb, ALB, or PA levels between the groups. Following the intervention, the study group exhibited significantly higher levels or each indicator than the control group (P < 0.05) (Table 3).

Table 3 Comparison of the nutritional indicators before and after nursing care mean, ± SD.

Group	n	Hb (g/L)		ALB (g/L)		PA (mg/L)
		Before	After	Before	After	Before	After
Study	50	57.14 ± 4.37	76.05 ± 5.19a	30.78 ± 3.11	45.12 ± 4.98a	281.25 ± 10.36	332.47 ± 15.06a
Control	50	58.02 ± 4.71	62.19 ± 5.07a	30.92 ± 3.14	38.26 ± 3.73a	282.09 ± 10.24	310.28 ± 14.77a
t		0.971	13.512	0.220	7.801	0.412	6.099
P value		0.335	0.001	0.825	0.000	0.683	0.000

^aP < 0.05 vs same group before and after nursing.

Continuous data were compared using independent samples student's t-test.

Hb: Hemoglobin; ALB: Albumin; PA: Prealbumin.

Comparison of quality of life scores before and after intervention

Pre-intervention assessments revealed no significant differences in WHOQOL-BREF scores between the groups. Post-intervention, the study group demonstrated significantly higher scores than the control group (P < 0.05) (Table 4). This included physical health, psychological well-being, social relationships, and environmental factors.

Table 4 Comparison of World Health Organization Quality of Life Brief scores between groups before and after nursing care, mean ± SD.

Group	n	Physical health		Psychological health		Social relationships		Environment		Total score
		Before	After	Before	After	Before	After	Before	After	Before	After
Study	50	17.45 ± 2.17	26.71 ± 3.19a	14.78 ± 2.36	23.19 ± 3.28a	10.78 ± 1.15	13.17 ± 1.12a	24.14 ± 2.29	31.21 ± 3.62a	68.15 ± 4.16	94.02 ± 4.39a
Control	50	17.52 ± 2.14	21.45 ± 3.13a	14.83 ± 2.28	19.23 ± 3.11a	10.78 ± 1.15	12.03 ± 1.24a	23.89 ± 2.29	28.36 ± 3.37a	68.08 ± 4.29	81.07 ± 5.23a
t		0.162	8.321	0.110	6.201	0.047	4.823	0.552	4.078	0.082	13.411
P value		0.087	0.000	0.909	0.000	0.118	0.001	0.582	0.000	0.931	0.000

^aP < 0.05 vs same group before and after nursing.

Continuous data were compared using independent samples Student's t-test. Interpretation of the World Health Organization Quality of Life Brief score: The domain and total scores range from zero to 100. Higher scores indicate a better quality of life. Scores are interpreted as: < 60 = poor; 60-79 = moderate; ≥ 80 = good quality of life.

Comparison of complication incidence rates between groups

At the two-month follow-up post-intervention, the complication rate in the study group was 4.0%, which was lower than the 18.0% rate in the control group (P < 0.05) (Table 5).

Table 5 Comparison of complication incidence between groups, n (%).

Group	n	Upper respiratory infection	Pleural effusion	Anastomotic leakage	Total cases
Control	50	2 (4.0)	0 (0)	0 (0)	2 (4.0)
Study	50	5 (10.0)	3 (6.0)	1 (2.0)	9 (18.0)
χ²					10.154
P value					0.001

Categorical data were compared using the χ² test (or Fisher's exact test if the expected cell count was < 5).

Comparison of nursing satisfaction between groups

Following a post-intervention questionnaire survey, nursing satisfaction in the study group was 94.0%, which was higher than 78.0% in the control group (P < 0.05) (Table 6).

Table 6 Comparison of nursing satisfaction between the groups, n (%).

Group	n	Very satisfied	Satisfied	Fair	Dissatisfied	Total satisfaction
Control	50	30 (60.0)	17 (34.0)	2 (4.0)	1 (2.0)	47 (94.0)
Study	50	19 (38.0)	20 (40.0)	7 (14.0)	4 (8.0)	39 (78.0)
χ²						9.255
P value						0.010

Categorical data are compared using the χ² test.

DISCUSSION

Tubular gastric substitution is a novel gastric reconstruction technique used in contemporary esophageal cancer resection procedures. Although it offers some degree of reduction in reflux compared with traditional approaches, postoperative reflux symptoms cannot be entirely prevented. This stems from the disruption of the normal physiological structure of the esophagus, compromising anti-reflux barriers such as the lower esophageal sphincter and the angle of His, thereby facilitating gastric content reflux[10-12]. The incidence of reflux after tubular gastric esophageal replacement surgery ranges from 6.7% to 32.5%, with some patients experiencing worsening symptoms over time[13,14]. These reflux symptoms not only cause physical discomfort but also significantly impair patients' quality of life. Consequently, the postoperative management of reflux symptoms warrants particular attention. Clinical follow-up combined with dietary and lifestyle interventions can help alleviate reflux symptoms. Patients often encounter complex living environments after discharge, combined with weak self-management skills and a lack of professional guidance, making it difficult to manage reflux symptoms effectively. Consequently, continuous comprehensive follow-up is necessary[16,17].

This retrospective analysis examined the follow-up nursing care for reflux symptoms in 100 patients who underwent tubular gastric esophageal replacement surgery. The control group received conventional follow-up care that primarily focused on dietary and medication interventions. The study group received comprehensive follow-up care and holistic nursing based on a thorough understanding of each patient's condition. This encompasses interventions at the cognitive, behavioral, and psychological levels, including health education, dietary management, lifestyle interventions, and psychological support. The results indicated that the pre-intervention 24-hour reflux frequency and reflux episodes lasting > 5 minutes were similar between groups. However, at the two-month follow-up, both metrics were significantly lower in the intervention group than in the control group (P < 0.05). This demonstrates that comprehensive follow-up nursing significantly reduces the frequency of reflux episodes after tubular gastric replacement surgery, effectively alleviating symptoms[18]. The findings of this study align with the evidence summarized by Zhao et al[2], who emphasized the importance of multimodal interventions for managing reflux symptoms after esophageal cancer surgery. However, compared to studies focusing primarily on surgical technical innovations or pharmacological therapy alone[12,15], this study highlights the unique value of a structured, multidisciplinary nursing support system in bridging the gap left by technical limitations and enhancing patient self-management capabilities.

Post-intervention symptom scores for heartburn, acid regurgitation, upper abdominal distension, and upper abdominal pain decreased in both groups compared with pre-intervention levels. This indicates that follow-up nursing alleviates reflux symptoms. Furthermore, the intervention group exhibited lower symptom scores across all parameters than the control group (P < 0.05), which is consistent with previous reports[19,20]. Thus, implementing comprehensive follow-up care along with routine follow-up measures more effectively reduces the severity of reflux symptoms, thereby alleviating postoperative suffering. This is likely attributable to the multifaceted approach of comprehensive follow-up care that improves postoperative reflux management through personalized dietary guidance, lifestyle adjustments, monitoring of medication adherence, and psychological support.

Beyond these surface-level mechanisms, deeper physiological and behavioral pathways may explain the more pronounced symptom improvement in the comprehensive care group. For instance, optimized nutrition not only reduces gastric pressure, but may also enhance esophageal mucosal resilience by improving microcirculation and supporting epithelial repair. Additionally, individualized dietary planning reduces exposure to foods that delay gastric emptying or stimulate acid secretion, such as high-fat or irritant meals, thereby addressing the pathophysiological drivers of reflux at their source. Psychological stabilization achieved through counseling may further modulate symptom perception. Stress and negative affect have been shown to influence esophageal sensitivity, lower esophageal sphincter tone, and autonomic regulation. Therefore, psychological interventions delivered during the comprehensive follow-up may have contributed to both objective symptom improvement and reduced subjective symptom burden.

To minimize assessment bias, all nursing staff involved in data collection received uniform training and used standardized inquiry language and assessment scales (e.g., the GERD Symptom Score scale). Patients in both groups received acid-suppressing medications (e.g., PPIs), ensuring basic medication control and limiting this factor as a confounder. Therefore, the differences in reflux symptom scores were more likely attributable to the effects of the comprehensive nursing interventions.

Regarding patient prognosis, nutritional indicators such as Hb, ALB, and PA were significantly higher in the study group post-intervention than in the control group. This suggests that sustained comprehensive follow-up care contributes to improved nutritional status, likely due to the dietary guidance and nutritional support incorporated within the comprehensive follow-up care[21]. A balanced dietary structure and timely nutritional supplementation help enhance the physical nutritional condition and alleviate poor appetite and nutritional depletion caused by postoperative reflux symptoms. Concurrently, the intervention group exhibited higher scores across all WHOQOL-BREF domains than the control group (P < 0.05). This may stem from comprehensive follow-up care that not only ameliorates physical conditions, but also provides psychological and social support. Such care alleviates anxiety and depression arising from postoperative reflux symptoms, thereby enhancing social confidence and environmental adaptability[22,23].

From a clinical prognostic perspective, the incidence of complications in the intervention group was 4.0%, which was significantly lower than the 18.0% observed in the control group. This demonstrates the efficacy of comprehensive follow-up care for preventing and detecting postoperative complications early, thereby enabling timely intervention for potential infections and fluid accumulation. A deeper mechanistic interpretation suggests that a reduction in respiratory infections may be linked to reduced aspiration risk[24]. Refluxates entering the upper airway during sleep contribute to postoperative respiratory infections. Comprehensive follow-up care through bedhead elevation, posture optimization, and avoidance of lying flat after meals likely minimizes micro-aspiration events. Improved nutritional status enhances immune function, whereas psychological stabilization may attenuate stress-related immunosuppression[25]. Together, these pathways form a plausible integrated mechanism for reduced complication rates. Conventional follow-up care solely involving health education and routine postoperative monitoring, although beneficial, lacks the depth required to generate synergistic protective effects.

Post-intervention questionnaires revealed a care satisfaction rate of 94.0% in the study group, which is significantly higher than the 78.0% in the control group (P < 0.05). This demonstrates that patients’ diverse needs during postoperative recovery are better addressed through comprehensive follow-up nursing that includes holistic, personalized, and continuous care services. This enhances patient recognition and satisfaction through an integrated follow-up nursing approach.

The strengths of this study include its multidimensional assessment framework (covering symptoms, nutrition, quality of life, and satisfaction) and the structured, comprehensive follow-up protocol delivered by a multidisciplinary team. This study provides a practical model for continuous care after surgery for esophageal cancer. However, this study has certain limitations. First, although the two-month follow-up period was sufficient to demonstrate short- to medium-term effectiveness, it did not capture long-term sustainability of outcomes. Second, this was a single-center study, and the patient population, surgical techniques, and nursing practices may not fully represent other regions or institutions, thereby limiting the generalizability of the findings. Third, the satisfaction survey employed a “self-designed questionnaire” without reporting reliability or validity indicators. The absence of psychometric testing means that measurement bias cannot be ruled out, and the observed differences in satisfaction may be influenced by the instrument itself rather than by the intervention alone. Additionally, although comprehensive care aims to empower patients and foster long-term healthy habits, the maintenance of these effects relies on patients' continued self-discipline after discharge. Future studies should incorporate multicenter designs, validated assessment tools, and extended follow-up durations to further strengthen this finding. Future research should incorporate longer follow-up periods to assess the effects of durability and explore the feasibility of lightweight long-term maintenance strategies through periodic booster sessions or digital health tools.

CONCLUSION

Comprehensive follow-up nursing for patients with reflux after tubular gastric esophageal replacement surgery effectively alleviated reflux symptoms, improved nutritional status, enhanced the quality of life, and reduced the incidence of complications, thereby demonstrating its clinical value.