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.
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.