In the Journals

Majority of severe GERD patients required long-term PPI use after antireflux surgery

Patients with severe GERD used proton pump inhibitors after antireflux surgery at much higher rates than previously reported, and more than half became long-term users 10 to 15 years after surgery, according to recent study data.

Anders Lødrup

Rates of PPI use before surgery were no DDD in 12.7% of patients, one to 89 DDD in 14.2%, 90 to 179 DDD in 13.3% and 180 or more DDD in 59.7% of the cohort. Cumulative risks for redeeming first PPI prescription after surgery were 57.5% at 5 years (95% CI, 55.8-59.2), 72.4% at 10 years (95% CI, 70.7-74.2) and 82.6% at 15 years (95% CI, 79.9-85.1). Risks for adopting long-term PPI use were 29.4% at 5 years (95% CI, 27.8-31), 41.1% at 10 years (95% CI, 39.2-43) and 56.6% at 15 years (95% CI, 53.5-59.7). Risks for prescription redemption after surgery and long-term use were significantly increased by female sex, older age, ARS performed in most recent years, previous use of PPI and use of nonsteroidal anti-inflammatory drugs or antiplatelet therapy.

“We have found that the majority of patients undergoing antireflux surgery are prescribed PPI post-surgically,” Lødrup told Healio.com. “Patients considering antireflux surgery should be informed of the high risk of later PPI use, especially if the primary purpose of the operation is to get patients off PPI therapy.”

The researchers concluded that, “if long-term PPI use after ARS is regarded as treatment failure, that is, as a proxy for inadequate symptom control, our study suggests that ARS may not be as effective as suggested by the outcomes from clinical trials.”

Disclosure: See the study for a full list of relevant financial disclosures.

Patients with severe GERD used proton pump inhibitors after antireflux surgery at much higher rates than previously reported, and more than half became long-term users 10 to 15 years after surgery, according to recent study data.

Using national health care registry data, Anders Lødrup, MD, department of medicine, Køge University Hospital, Denmark, and colleagues performed a nationwide retrospective follow-up study of 3,465 adult GERD patients (43% women) who underwent first-time antireflux surgery (ARS) from 1996 to 2010. Assessments were based on pre- and post-surgery proton pump inhibitor (PPI) use, including evidence of long-term use defined as a mean of at least one-half defined daily dose (DDD) per day, or 180 DDD annually.

Anders Lødrup

Rates of PPI use before surgery were no DDD in 12.7% of patients, one to 89 DDD in 14.2%, 90 to 179 DDD in 13.3% and 180 or more DDD in 59.7% of the cohort. Cumulative risks for redeeming first PPI prescription after surgery were 57.5% at 5 years (95% CI, 55.8-59.2), 72.4% at 10 years (95% CI, 70.7-74.2) and 82.6% at 15 years (95% CI, 79.9-85.1). Risks for adopting long-term PPI use were 29.4% at 5 years (95% CI, 27.8-31), 41.1% at 10 years (95% CI, 39.2-43) and 56.6% at 15 years (95% CI, 53.5-59.7). Risks for prescription redemption after surgery and long-term use were significantly increased by female sex, older age, ARS performed in most recent years, previous use of PPI and use of nonsteroidal anti-inflammatory drugs or antiplatelet therapy.

“We have found that the majority of patients undergoing antireflux surgery are prescribed PPI post-surgically,” Lødrup told Healio.com. “Patients considering antireflux surgery should be informed of the high risk of later PPI use, especially if the primary purpose of the operation is to get patients off PPI therapy.”

The researchers concluded that, “if long-term PPI use after ARS is regarded as treatment failure, that is, as a proxy for inadequate symptom control, our study suggests that ARS may not be as effective as suggested by the outcomes from clinical trials.”

Disclosure: See the study for a full list of relevant financial disclosures.