Despite High Satisfaction, Majority of Gastro-oesophageal Reflux Disease Patients Continue to Use Proton Pump Inhibitors After Antireflux Surgery

A.Madan; A. Minocha


Aliment Pharmacol Ther. 2006;23(5):601-605. 

In This Article

Summary and Introduction


Background: While antireflux surgery is effective in controlling symptoms of gastro-oesophageal reflux, its role in eliminating the use of antireflux medicines after surgery and as such its long-term cost-effectiveness remains controversial.
Aim: To assess the patient satisfaction and the continued medication use following laparoscopic Nissen fundoplication at a tertiary level community hospital.
Methods: Adult patients who underwent laparoscopic Nissen fundoplication at our institution over a period of over 3 years were asked to complete a questionnaire recording their demographic information, date and reason for the surgery, preprocedure and postprocedure symptoms, smoking and alcohol use, and medication use preoperatively and post-operatively. Patients were also asked about their satisfaction with surgery.
Results: One hundred patients participated in the study. Overall, 90% patients experienced satisfaction with their surgery. Eighty percentage patients were willing to undergo surgery again, if needed. Over two-thirds (67%) patients had decrease in the severity of their symptoms. None of the patients had worsening of symptoms post-operatively. However, 80% patients were still taking antireflux medications including proton pump inhibitors (53%).
Conclusions: Most patients continue to use antireflux medications including after laparoscopic Nissen fundoplication despite high satisfaction with surgery.


Although both medical and surgical therapies are effective for management of gastro-oesophageal reflux disease (GERD), there is controversy about the cost-effectiveness of the antireflux surgery for long-term management of GERD. Compounding the difficulty in measuring cost-effectiveness is the fact that there is limited data on the ability of antireflux surgery to eliminate the need for antireflux medications after surgery.

Widely accepted indications for antireflux surgery in patients with GERD are threefold: (i) individuals who are intolerant of proton pump inhibitor (PPI) therapy because of side-effects, (ii) poor compliance to medical therapy and (iii) individuals who desire a permanent solution to their reflux problem that frees them of the need to chronically consume medications.[1] The latter is usually related to the cost issues or that the patient may not be comfortable with taking medical therapy for potentially lifelong period because of possible risk of adverse effects from drug use over several decades.

However, does this procedure in fact provide a permanent solution to GERD problem? Are patients really freed from the need to consume pharmaceuticals? Our study attempts to answer this important question: How well can we give a guarantee to the patient that after the antireflux surgery, he or she would not require long-term antireflux medications especially the expensive PPIs.

Data from surgical literature has shown excellent response to surgery with marked decrease in medication use and improved quality of life up to 8 years after laparoscopic Nissen fundoplication (LNF).[2] Data from medical literature have shown good response to surgery but with the cost of continued need to consume the medications.[3] Also most of the studies have come out of major tertiary care referral centres, some of them from European centres. The big question that still looms large is whether we can replicate these data in a community setting in the United States.

We conducted a study to assess the patient satisfaction with surgery and medication use among patients who had undergone LNF in a tertiary level community hospital.