Recurrent Reflux Still Common in Some, Despite Antireflux Surgery
Older women with comorbidities have a higher risk of recurrent gastroesophageal reflux following primary laparoscopic antireflux surgery, requiring long-term medication use or secondary antireflux surgery, according to a recent study.
Previous studies have reported high incidence of reflux recurrence following antireflux surgery. However, little is known about what factors influence reflux recurrence following laparoscopic antireflux surgery.
____________________________________________________________________________________________________________
RELATED CONTENT
Mediterranean Diet Is as Effective as Pharmacotherapy in Treating Reflux
Study: Acid Reflux Drug Increases Kidney Disease Risk
____________________________________________________________________________________________________________
For their study, the researchers assessed 2655 patients who received antireflux surgery between January 1, 2005, and December 31, 2014. Patient data was obtained from the Swedish Patient Registry, the Swedish Cause of Death Registry, and the Prescribed Drug Registry. Patient ages ranged from 40.0 years to 61.0 years. Follow-up lasted a median of 5.6 years.
The primary outcome was reflux recurrence, which was defined as secondary antireflux surgery or the use of antireflux medication including proton pump inhibitors or histamine2 receptor agonists more than 6 months. Risk factors for reflux recurrence were investigated via multivariable Cox regression.
Results indicated that 470 patients (17.7%) experienced reflux recurrence. Of these, 393 (83.6%) received long-term antireflux medication, and 77 (16.4%) underwent secondary antireflux surgery. Risk factors associated with reflux recurrence were female sex, older age, and the presence of comorbidities. The researchers noted that hospital volume of antireflux surgery was not associated with the risk of reflux recurrence.
“Among patients who underwent primary laparoscopic antireflux surgery, 17.7% experienced recurrent gastroesophageal reflux requiring long-term medication use or secondary antireflux surgery,” the researchers concluded. “Risk factors for recurrence were older age, female sex, and comorbidity. Laparoscopic antireflux surgery was associated with a relatively high rate of recurrent gastroesophageal reflux disease requiring treatment, diminishing some of the benefits of the operation.”
—Christina Vogt
Reference:
Maret-Ouda J, Wahlin K, El-Serag HB, Lagergren J. Association between laparoscopic antireflux surgery and recurrence of gastroesophageal reflux JAMA. 2017;318(10):939-946. doi:10.1001/jama.2017.10981