In the Journals

More than 1 in 6 laparoscopic antireflux surgery patients experience GERD recurrence

Nearly 18% of patients who underwent primary laparoscopic antireflux surgery experienced recurrent gastroesophageal reflux necessitating secondary antireflux surgery or long-term medication use, according to findings recently published in JAMA.

“Reflux recurrence after laparoscopic antireflux surgery has not been assessed in a long-term population-based study of unselected patients,” John Maret-Ouda, MD, of the department of molecular medicine and surgery at Karolinska University Hospital, Stockholm, and colleagues wrote.

To gain a better understanding, researchers analyzed data from 2,655 adult patients from Sweden who had antireflux surgery from Jan. 1, 2005, to Dec. 31, 2014. Fifty-one percent of patients were men, and the median participant age was 51 years.

During follow-up (median, 5.6 years), 17.7% of patients had reflux recurrence. Researchers speculated that the lower recurrence rate of gastroesophageal reflux disease (GERD), when compared to previous studies, may be attributable to the larger sample size, the more complete follow-up, and that laparoscopic antireflux surgery has become more centralized to expert centers.

Among patients with reflux recurrence, 16.4% underwent secondary antireflux surgery and 83.6% received long-term antireflux medication.

Maret-Ouda and colleagues also found that risk factors for GERD recurrence included comorbidity (HR for Charlson comorbidity index score 1 vs. 0 = 1.36; 95% CI, 1.13-1.65); older age (HR for age 61 years vs. 45 years = 1.41; 95% CI, 1.1-1.81); and female sex (HR = 1.57; 95% CI, 1.29-1.9).

“Laparoscopic antireflux surgery was associated with a relatively high rate of recurrent gastroesophageal reflux disease requiring long-term medication or secondary antireflux surgery, diminishing some of the benefits of the operation,” the researchers wrote.

In a related editorial, Stuart J. Spechler, MD, from the Center for Esophageal Diseases at Baylor University Medical Center, Dallas, noted that with only two established options available to treat recurrent GERD, clinicians must thoroughly discuss the risks and benefits of treatment with their patients.

“Whether the greater than 80% possibility of long-term freedom from [proton pump inhibitors] and their associated risks warrants the 4% risk of acute surgical complications and the 17.7% risk of GERD recurrence is a decision that individual patients should make after a detailed discussion of these risks and benefits with their physicians. There are wide variations among individuals in how they perceive and deal with different risks, and those factors should play a major role in guiding management choices,” Spechler wrote. – by Janel Miller

Disclosures : Spechler reports consulting for Ironwood Pharmaceuticals and Takeda Pharmaceuticals. The other researchers report no relevant financial disclosures.

Nearly 18% of patients who underwent primary laparoscopic antireflux surgery experienced recurrent gastroesophageal reflux necessitating secondary antireflux surgery or long-term medication use, according to findings recently published in JAMA.

“Reflux recurrence after laparoscopic antireflux surgery has not been assessed in a long-term population-based study of unselected patients,” John Maret-Ouda, MD, of the department of molecular medicine and surgery at Karolinska University Hospital, Stockholm, and colleagues wrote.

To gain a better understanding, researchers analyzed data from 2,655 adult patients from Sweden who had antireflux surgery from Jan. 1, 2005, to Dec. 31, 2014. Fifty-one percent of patients were men, and the median participant age was 51 years.

During follow-up (median, 5.6 years), 17.7% of patients had reflux recurrence. Researchers speculated that the lower recurrence rate of gastroesophageal reflux disease (GERD), when compared to previous studies, may be attributable to the larger sample size, the more complete follow-up, and that laparoscopic antireflux surgery has become more centralized to expert centers.

Among patients with reflux recurrence, 16.4% underwent secondary antireflux surgery and 83.6% received long-term antireflux medication.

Maret-Ouda and colleagues also found that risk factors for GERD recurrence included comorbidity (HR for Charlson comorbidity index score 1 vs. 0 = 1.36; 95% CI, 1.13-1.65); older age (HR for age 61 years vs. 45 years = 1.41; 95% CI, 1.1-1.81); and female sex (HR = 1.57; 95% CI, 1.29-1.9).

“Laparoscopic antireflux surgery was associated with a relatively high rate of recurrent gastroesophageal reflux disease requiring long-term medication or secondary antireflux surgery, diminishing some of the benefits of the operation,” the researchers wrote.

In a related editorial, Stuart J. Spechler, MD, from the Center for Esophageal Diseases at Baylor University Medical Center, Dallas, noted that with only two established options available to treat recurrent GERD, clinicians must thoroughly discuss the risks and benefits of treatment with their patients.

“Whether the greater than 80% possibility of long-term freedom from [proton pump inhibitors] and their associated risks warrants the 4% risk of acute surgical complications and the 17.7% risk of GERD recurrence is a decision that individual patients should make after a detailed discussion of these risks and benefits with their physicians. There are wide variations among individuals in how they perceive and deal with different risks, and those factors should play a major role in guiding management choices,” Spechler wrote. – by Janel Miller

Disclosures : Spechler reports consulting for Ironwood Pharmaceuticals and Takeda Pharmaceuticals. The other researchers report no relevant financial disclosures.