Absence of gastroesophageal reflux disease in a majority of patients taking acid suppression medications after Nissen fundoplication

Lord, Reginald V.; Kaminski, Anna; Bowrey, David J.; Crookes, Peter F.; Wood, Michael G.; Mason, Rodney J.; Wajed, Saj; Hagen, Jeffrey A.; DeMeester, Steven R.; Streets, Christopher G.; Peters, Jeffrey H.; DeMeester, Tom R.

doi:10.1016/s0016-5085(08)80214-4

Cited by 27 publications

(31 citation statements)

References 17 publications

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“…33 One main reason for the continued decline of antireflux may be the growing literature raising questions about its long-term effectiveness, especially with many patients back on antireflux medications. 8,14,15,34,35 This concern, coupled with the aggressive marketing of PPIs by pharmaceutical companies, including directto-consumer advertising, the OTC availability, and increasing affordability of PPIs, may have reduced patient referrals for antireflux surgery by gastroenterologists, especially for younger patients. The reason for taking the antireflux medications is less clear as the majority of patients were satisfied with their surgery and less than 25% of them had evidence of abnormal esophageal acid exposure on the 24-hour pH study.…”

Section: Discussionmentioning

confidence: 99%

Trends and perioperative outcomes of inpatient antireflux surgery in the United States, 1993-2006

Wang

Dempsey

Richter³

2010

Diseases of the Esophagus

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Antireflux surgery is an effective treatment for gastroesophageal reflux disease, but postoperation complications and durability may be problematic. The objective of the study was to determine whether inpatient antireflux surgery continued to decline in the United States due to concerns about its long-term effectiveness and the popularity of gastric bypass surgery and to assess recent changes in its perioperative outcomes. Using the Nationwide Inpatient Sample, we identified adult patients undergoing inpatient antireflux surgery during 1993-2006 and compared the trends of inpatient antireflux surgery with inpatient gastric bypass surgery. Perioperative complications included laceration, splenectomy, transfusion, esophageal dilation, total parenteral nutrition, and infection. Inpatient antireflux surgery increased from 9173 in 1993 to 32 980 in 2000 (+260%) but then decreased to 19 668 in 2006 (-40%). Compared with 2000, patients undergoing inpatient antireflux surgery in 2006 were older (49.9 ± 32.4 vs. 54.6 ± 33.6 years) and had a longer length of stay (3.1 ± 10.0 vs. 3.7 ± 13.4 days), more complications (4.7% vs. 6.1%), and higher mortality (0.26% vs. 0.54%) (all P < 0.05). Compared with inpatient gastric bypass surgery, length of stay was longer and mortality was higher for inpatient antireflux surgery in 2006, but neither was significant controlling for age. In 2006, perioperative outcomes of inpatient antireflux surgery were better in high-volume hospitals (all P < 0.01). Inpatient antireflux surgery continued to decline in the United States from 2000 to 2006, concomitant with a dramatic increase in inpatient gastric bypass surgery. Older patient age and worsening perioperative outcomes for inpatient antireflux surgery suggest increased medical complexity and possibly a larger share of reoperations over time. Designating centers of excellence for antireflux surgery based on local expertise may improve outcomes.

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Section: Discussionmentioning

confidence: 99%

Trends and perioperative outcomes of inpatient antireflux surgery in the United States, 1993-2006

Wang

Dempsey

Richter³

2010

Diseases of the Esophagus

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“…Despite specialist centres reporting success rates for laparoscopic fundoplication of 90-95 per cent 2 , the true failure rate depends on the definitions used. Up to 50 per cent of patients may continue to use antireflux medication after fundoplication 3 , even though only a minority of them have proven pathological reflux 4,5 and only 5-10 per cent ultimately require revisional surgery 6,7 .…”

Section: Introductionmentioning

confidence: 99%

Long-term outcomes of revisional surgery following laparoscopic fundoplication

Lamb

Myers

Jamieson

et al. 2009

British Journal of Surgery

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“…Similarly, its use does not define fundoplication failure since this does not correlate with symptomatic outcomes or objective findings of reflux. 5,6,10,18,32 A limitation of this study is that we did not compare anti-reflux surgery with long-term medical treatment for GERD. The need for such studies was evident in a Cochrane review in which four randomized controlled trials comparing the outcome of laparoscopic fundoplication with that of PPIs were selected.…”

Section: Discussionmentioning

confidence: 99%

“…However, several studies have demonstrated improved quality of life (QoL), patient satisfaction and symptom control when following up patients to 20 years after surgery. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] A variety of instruments for measuring QoL occur in the literature. [20][21][22][23][24][25] Some studies combine reports of post-surgical symptoms and QoL.…”

Section: Introductionmentioning

confidence: 99%

Quality of life and gastric acid‐suppression medication 20 years after laparoscopic fundoplication

Campanello

Westin

Unosson

et al. 2019

ANZ Journal of Surgery

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Background Laparoscopic fundoplication is an effective treatment for gastro‐oesophageal reflux disease (GERD). We aimed to assess quality of life (QoL), long‐term residual symptoms, patient satisfaction and use of acid‐suppression medication at 5, 10 and 20 years after surgery. Methods We identified a cohort of 100 patients who underwent laparoscopic fundoplication between 1993 and 1998. The validated QoL questionnaires Short Form health survey (SF‐36), and Quality‐of‐Life in Reflux and Dyspepsia (QOLRAD), as well as a specific questionnaire regarding post‐fundoplication symptoms, were sent to the patients at 5, 10 and 20 years after surgery. Furthermore, patients who reported using the acid‐suppression medication after 20 years were interviewed by telephone regarding their reason for taking it. Results Eighty‐eight percent of the patients responded at 5 and 10 years post‐surgery. Twenty years following fundoplication, 68 (84% of those still alive) patients completed the questionnaires. The patients had equivalent health‐related QoL scores in both the QOLRAD and SF‐36 questionnaires after 10 and 20 years, and those scores were in line with a Swedish age‐matched population. After 20 years, 87% were satisfied with the results, and 84% of the patients would recommend reflux surgery to a relative or a friend. At the telephone interview, 32% (22/68) confirmed using acid‐suppression medication, but only half (11/68) used it because of reflux symptoms. Conclusion The long‐term, satisfying outcomes in GERD symptoms and QoL 5 and 10 years after surgery were maintained at a 20‐year follow‐up. Half of the patients used acid‐suppression medication for reasons other than GERD symptoms.

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Absence of gastroesophageal reflux disease in a majority of patients taking acid suppression medications after Nissen fundoplication

Cited by 27 publications

References 17 publications

Trends and perioperative outcomes of inpatient antireflux surgery in the United States, 1993-2006

Trends and perioperative outcomes of inpatient antireflux surgery in the United States, 1993-2006

Long-term outcomes of revisional surgery following laparoscopic fundoplication

Quality of life and gastric acid‐suppression medication 20 years after laparoscopic fundoplication

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