Medication usage and additional esophageal procedures after antireflux surgery

One of the goals of antireflux surgery (ARS) is to lower medications usage for heartburn symptoms. There has been some controversy as to whether this is accomplished by surgery. In addition, there is little comparative data of medical usage in patients suffering from gastroesophageal reflux disease (GERD) treated nonoperatively with those treated with surgery, and no data on additional esophageal procedures, such as upper endoscopy or dilation. The purpose of this study was to determine these differences in a matched group of medically and surgically treated patients with at least 1 year of follow-up. All patients who underwent ARS with at least 1 year of follow-up were included. These patients were matched to a group of medically treated patients for gender, age, and month of surgery to month of gastroenterologic clinic visit. Information was gathered through the medical record or direct contact for the present use of medications and additional esophageal procedures related to GERD. One hundred twenty-two patients in each group were studied. Medication usage consisted of 13% of ARS patients versus 95% of medical patients (P < 0.0001). ARS patients had used 359 patient-months of medications versus 3578 in the medical group (P < 0.0001). Only 25% of ARS patients prescribe medications actually responded to their use. Additional procedures consisted of 9% of ARS patients versus 64% of medical patients (P < 0.0001). In conclusion, ARS leads to decreased medication use and to decreased use of subsequent esophageal procedures. In addition, most postoperative ARS patients placed on medications do not respond, and therefore require an objective evaluation for their symptoms.