Long-term efficacy and quality of life after antireflux surgery

Antireflux surgery (ARS) has been found to be an effective treatment of gastro-esophageal reflux disease (GERD); however, the long-term effects are uncertain. This study aimed to evaluate the long-term efficacy of ARS on quality of life, symptom severity, and use of proton pump inhibitors (PPIs).

A validated GERD Health-Related Quality of Life (GERD-HRQL) Questionnaire was sent to 419 patients who underwent ARS at Aarhus University Hospital from January 2012 to April 2020. Patient records were reviewed retrospectively. The Danish National Prescription Registry was used to collect data on the use of PPIs before and after ARS.

A response rate of 71% resulted in a total of 164 patients included in the study with a median follow-up time of 4.8 years (interquartile range: 2.5-6.7). The total GERD-HRQL median score at follow-up was 11.5 (IQR: 4-22). The proportion of patients experiencing daily symptoms of heartburn and regurgitation was significantly reduced pre- to postoperatively from 90 to 70% to 32% and 29%, respectively. Five years after surgery, 47% of patients had completely ceased PPI usage, while 44% were long-term users.

A lasting long-term effect of ARS on GERD symptoms was found, although almost a third of patients still experience heartburn and/or regurgitation daily. Almost half of patients were not taking PPIs 5 years after ARS, but 44% became long-term users. Patients should be made aware that long-term PPI therapy often is necessary following ARS.