Use of proton pump inhibitors after antireflux surgery: a nationwide register-based follow-up study

Abstract

ObjectiveAntireflux surgery (ARS) has been suggested as an alternative to lifelong use of proton pump inhibitors (PPI) in reflux disease. Data from clinical trials on PPI use after ARS have been conflicting. We investigated PPI use after ARS in the general Danish population using nationwide healthcare registries.DesignA nationwide retrospective follow-up study of all patients aged ≥18 and undergoing first-time ARS in Denmark during 1996–2010. Two outcome measures were used: redemption of first PPI prescription after ARS (index prescription) and a marker of long-term use, defined by an average PPI use of ≥180 defined daily doses (DDDs) per year. Kaplan–Meier curves and Cox proportional hazards model were used for statistics.Results3465 patients entered the analysis. 12.7% used no PPI in the year before surgery, while 14.2%, 13.4% and 59.7% used 1–89 DDD, 90–179 DDD and ≥180 DDD, respectively. Five-, 10- and 15-year risks of redeeming index PPI prescription were 57.5%, 72.4% and 82.6%, respectively. Similarly, 5-, 10- and 15-year risks of taking up long-term PPI use were 29.4%, 41.1% and 56.6%. Female gender, high age, ARS performed in most recent years, previous use of PPI and use of nonsteroidal anti-inflammatory drugs or antiplatelet therapy significantly increased the risk of PPI use.ConclusionsRisk of PPI use after ARS was higher than previously reported, and more than 50% of patients became long-term PPI users 10–15 years postsurgery. Patients should be made aware that long-term PPI therapy is often necessary after ARS.

BOB CAT: a Large-Scale Review and Delphi Consensus for Management of Barrett’s Esophagus With No Dysplasia, Indefinite for, or Low-Grade Dysplasia

“…No difference in the incidence of EA was seen in one follow-up study of an RCT, and this study concluded that surgery alone will not prevent EA or remove the need for antisecretory medication (180,181). Recently, it was shown that progression to cancer after antireflux surgery is mainly related to late recurrence of reflux (182,183).…”

Use of acid‐suppressive therapy before anti‐reflux surgery in 2922 patients: a nationwide register‐based study in Denmark

“…Whether patients on low pre‐surgical dosing may experience a lesser effect of ARS cannot be determined from our results, but in general non‐compliance to acid‐suppressive drugs makes it difficult to weigh the pros and cons of a surgical intervention, intended to be an alternative to failed medical therapy. Previously, we have shown that 25% of the Danish ARS patients, who were not using any PPI in the year before ARS, went on to take up long‐term PPI use (≥180 DDD per year) following surgery . Many of these patients could possibly have been managed on medical therapy alone and thereby avoided surgery.…”

“…In a recent register-based study we observed that the use of PPI 1 year before surgery was surprisingly low. 4 However, these results were not the primary outcome of that study and did not include data on use of histaminereceptor-2-antagonists (H 2 RA). Furthermore, in that study we had no data on oesophageal manometry, pHor impedance monitoring.…”

Management of Barrett esophagus: a practical guide for clinicians based on the BADCAT and BoB CAT recommendations

“…[34][35][36] Until then, empirical advice would be to minimize symptomatic and nonsymptomatic reflux with an effective PPI dose twice daily. If symptoms occur or endoscopic damage is apparent, higher-dose PPI therapy should be employed twice daily.…”