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Chronic Medication Use After Antireflux Surgery
About half of all patients who undergo antireflux surgery require sustained use of antireflux medications.
Surgery for gastroesophageal reflux disease (GERD) has become increasingly common, but does it really reduce long-term use of antireflux medications? To answer this question, investigators reviewed postsurgery data on all adults who underwent antireflux surgery at Veterans Affairs medical centers between mid-1990 and early 2001. Medication use was determined for 2406 patients who had at least 1 year of follow-up after surgery.
During a median follow-up of 4.5 years, 49.8% of patients received at least three prescriptions for GERD medications, including proton-pump inhibitors (34%), H2-receptor antagonists (24%), and promotility agents (9%). Complications of surgery included dysphagia (19%), esophageal dilation (6%), and redo-fundoplication (2%). The 30-day surgical mortality rate was 0.8%.
Comment: These findings from a national VA database might be more generalizable than findings from highly specialized tertiary referral centers, because they more closely reflect the surgical experience and expertise found in community hospitals. In a previous VA study, 62% of patients had sustained use of antireflux medications during a median 6.3 years after antireflux surgery (JAMA 2001; 285:2331). Together, these two studies suggest that sustained use of antireflux medications is the "rule" rather than the exception after antireflux surgery. Patients considering such surgery should be advised of this likelihood. In addition, cost-effectiveness analyses of antireflux surgery should incorporate the costs of not only sustained medication use, but also management of complications.
— David A. Johnson, MD
Published in Journal Watch Gastroenterology April 11, 2006
Citation(s):
Dominitz JA et al. Complications and antireflux medication use after antireflux surgery. Clin Gastroenterol Hepatol 2006 Mar; 4:299-305.
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