Medication usage and additional esophageal procedures after antireflux surgery

Area of Science:

• Gastroenterology
• Surgical Innovation
• Comparative Effectiveness Research

Background:

• Antireflux surgery (ARS) aims to decrease medication use for heartburn, but its effectiveness compared to medical management for gastroesophageal reflux disease (GERD) is debated.
• Limited comparative data exists on medication and additional esophageal procedure usage between surgically and non-surgically treated GERD patients.

Purpose of the Study:

• To compare medication usage and the need for subsequent esophageal procedures in patients with GERD treated with ARS versus medical management.
• To evaluate the effectiveness of prescribed medications in patients following ARS.

Main Methods:

• A matched-group study comparing 122 patients undergoing ARS with 122 medically treated GERD patients with at least 1-year follow-up.
• Data collected via medical records and direct contact regarding medication use and additional esophageal procedures (e.g., endoscopy, dilation).
• Patients matched for gender, age, and time of treatment initiation.

Main Results:

• Medication usage was significantly lower in the ARS group (13%) compared to the medical group (95%) (P < 0.0001).
• Total medication use was substantially less in ARS patients (359 patient-months) versus the medical group (3578 patient-months) (P < 0.0001).
• Fewer ARS patients required additional esophageal procedures (9%) compared to the medical group (64%) (P < 0.0001).

Conclusions:

• Antireflux surgery significantly decreases the need for ongoing medication and subsequent esophageal interventions for GERD.
• A majority of ARS patients prescribed medications post-surgery do not respond, indicating a need for objective symptom evaluation.