Chronic PPI use after anti-reflux surgery: a retrospective observational pilot study

Chronic Proton Pump Inhibitor (PPI) use after anti-reflux surgery (ARS) remains common. Which patient factors contribute to chronic PPI use after surgery is unclear. The primary aim was to provide a long-term outcome of ARS by evaluating PPI use in the years after surgery and identify determinants of chronic PPI use after surgery.

Patients aged ≥ 18 years who underwent ARS between 2011 and 2020 in a single referral center were eligible. Patient data were retrospectively assessed by medical record review. PPI data were acquired from primary care pharmacies. Chronic PPI use was defined as ≥ 180 Defined Daily Doses (DDD) per year. Patient characteristics predisposing chronic PPI use were identified. Statistical analysis included descriptive statistics and multivariable logistic regressions and a Kaplan-Meier curve.

Only 45 out of 364 eligible patients (12%) had complete data for analysis. Chronic PPI use was present in 79.5% before surgery compared to 29.5% at 1 and 2 years and 32.0% for 5 years after surgery. A median difference in PPI use of -257 DDD was found for the year after surgery compared to the year before surgery. Male gender was associated with chronic PPI use after surgery but no other determinants were found.

Approximately a third of the patients use PPIs up to 5 years after surgery. Although ARS is recommended when PPI treatment fails or to avert lifelong PPI use, quality of life and PPI use may not correlate linearly. Adequate patient selection and expectation management before surgery is paramount.