Utilisation of surgical fundoplication for patients with gastro‐oesophageal reflux disease in the USA has declined rapidly between 2009 and 2013

Abstract

Utilisation of surgical fundoplication in GERD patients has been steadily declining over the past 5 years. The vast majority of patients will resume PPI treatment after surgical fundoplication.

The added diagnostic value of postreflux swallow‐induced peristaltic wave index and nocturnal baseline impedance in refractory reflux disease studied with on‐therapy impedance‐pH monitoring

“…At multivariate logistic regression analysis, the PSPW index resulted an independent predictor of PPI‐refractory GERD as confirmed by positive surgical outcome. Despite the efficacy of laparoscopic fundoplication, side effects have limited its utilization: therefore, a firm diagnosis of PPI–refractory GERD is warranted before advising surgery . Our results suggest that low values of PSPW index in PPI‐refractory heartburn patients studied with on‐therapy impedance‐pH monitoring can increase our confidence in distinguishing PPI‐refractory GERD from FH and in advising antireflux interventions.…”

“…[5][6][7][8] The number of reflux events at on-therapy impedance-pH monitoring is directly related to AET at off-therapy pH testing, 7 but few studies have documented the clinical utility of this parameter in PPI-refractory patients evaluated during ongoing therapy. 8,10,11,19 Despite their well-recognized limitations, symptom-reflux association indexes are considered worthwhile for the clinical evaluation of patients with suspected reflux disease 24 : however, their positivity is directly related to high reflux rates, 9 only a minority of reflux events are associated with symptoms, 25 Despite the efficacy of laparoscopic fundoplication, 26,27 side effects have limited its utilization 28 : therefore, a firm diagnosis of PPI-refractory GERD is warranted before advising surgery. 2,4 Our results suggest that low values of PSPW index in PPI-refractory heartburn patients studied with on-therapy impedance-pH monitoring can increase our confidence in distinguishing PPI-refractory GERD from FH and in advising antireflux interventions.…”

“…PSPW index (%) 21 (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29) 22 (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33) . Laparoscopic fundoplication leads to a sub-total abolition of total, acidic and weakly acidic reflux events.…”

Alternative therapies for GERD: a way to personalized antireflux surgery

“…Gastroenterologists tend to limit their referrals for fundoplication only to patients with long‐lasting severe disease and large hiatal hernias. A downward trend in the utilization of surgical fundoplication has been noted in the United States over the past decade . Novel potentially less invasive options for sphincter augmentation will be discussed.…”

“…A downward trend in the utilization of surgical fundoplication has been noted in the United States over the past decade. [21][22][23] Novel potentially less invasive options for sphincter augmentation will be discussed. Table 1 outlines some pros and cons of methods discussed.…”