Timeline for reinitiation of antireflux medication post-surgical or endoscopic antireflux procedures

Although various antireflux interventions are available for gastroesophageal reflux disease (GERD), the duration these interventions effectively maintain patients off antireflux medications remains inadequately characterized. This study evaluates the time to reinitiation of antireflux medications (proton pump inhibitors [PPIs] or histamine-2 receptor antagonists [H2RAs]) following surgical or endoscopic procedures for GERD. This population-based analysis utilized the U.S. Collaborative Network database within TriNetX. Adult GERD patients (≥18 years) who underwent surgical fundoplication, magnetic sphincter augmentation (LINX™), Stretta procedure, or endoscopic fundoplication were identified. The index date was defined as the date of first recorded antireflux procedure after GERD diagnosis. The primary outcome was time to reinitiation of antireflux medication (PPIs or H2RAs), analyzed using Kaplan-Meier survival curves. Secondary outcomes included time to reinitiation of PPI alone and cumulative risks of medication resumption at 1-, 5-, 10-, and 15-year post-antireflux intervention. A total of 44,343 GERD patients underwent surgical fundoplication, 868 LINX™, 294 Stretta procedure, and 510 endoscopic fundoplication. Median time to medication reinitiation was 18.2 months (95% confidence interval [95%CI] 17.7-18.8) following surgical fundoplication, with a 5-year risk of 71.6%. LINX™ demonstrated a longer median time to reinitiation (39.0, 95%CI 31.4-47.6 months) and a lower 5-year risk (59.8%). Stretta procedure and endoscopic fundoplication showed shorter median times (6.2 and 8.8 months, respectively), with almost 80% resuming medications at 5 years. Male sex was an independent predictor of PPI reinitiation following LINX™ (HR.1.623; 95%CI 1.045-2.523). Most patients who underwent surgical or endoscopic antireflux procedures resumed antireflux medications within 5 years after the intervention.