GERD recurrence appears common after laparoscopic antireflux surgery

Gastroesophageal reflux disease (GERD) may often recur after laparoscopic antireflux surgery, according to a recent study.

Researchers in Sweden performed a population-based cohort study using national databases to determine the risk for recurrence of reflux after laparoscopic antireflux surgery, as well as risk factors for such recurrence. Patients who had antireflux surgery between Jan. 1, 2005, and Dec. 31, 2014, were included in the study. The main outcome measure, reflux recurrence, was defined as use of proton-pump inhibitors (PPIs) or histamine₂ receptor antagonists for more than six months, or secondary antireflux surgery. Results were published Sept. 12 by JAMA.

Overall, 2,655 patients were included in the study. The median age was 51 years, and 51% were men. Follow-up was a median of 5.6 years. In that time, 470 patients (17.7%) had reflux recurrence, 30.2% in the first year after surgery and 48.7% within two years of surgery. Three hundred ninety-three of 470 patients (83.6%) were then treated with antireflux medications, and 77 of 470 (16.4%) had secondary antireflux surgery. Recurrence was more likely in women (hazard ratio, 1.57 [95% CI, 1.29 to 1.90] for women vs. men), older patients (hazard ratio, 1.41 [95% CI, 1.10 to 1.81] for patients ≥61 years of age vs. ≤45 years of age), and those with comorbid conditions (hazard ratio, 1.36 [95% CI, 1.13 to 1.65] for Charlson comorbidity index score ≥1 vs. 0). One hundred nine patients (4.1%) experienced a complication within 30 days of the first antireflux surgery, most commonly infection (1.1%), bleeding (0.9%), and esophageal perforation (0.9%).

The authors noted that data were not available on unmeasured confounders or reflux symptoms and that the definition of reflux recurrence may not have been accurate, among other limitations. However, they concluded that their study found a significant rate of GERD recurrence after antireflux surgery that required ongoing treatment, making the surgery less beneficial over the long term.

An accompanying editorial noted that despite the 17.7% rate of recurrence, antireflux surgery appears to yield long-term benefit in most patients, especially young, healthy men. The editorialist also pointed out that PPIs have been linked to adverse effects and that they would no longer be needed if antireflux surgery is successful.

“The question for clinicians is how to advise patients with severe erosive GERD to choose between their only 2 established therapeutic options—antireflux surgery or long-term PPIs,” the editorialist wrote. “Whether the greater than 80% possibility of long-term freedom from PPIs 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.”