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October 10, 2001

Medical vs Surgical Treatment of Gastroesophageal Reflux

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor

JAMA. 2001;286(14):1709-1712. doi:10.1001/jama.286.14.1709

To the Editor: Dr Spechler and colleagues1 found an unexpectedly high usage of antireflux medications in patients after surgical therapy for GERD. They state that 62% of patients were using antireflux medications and that 32% of patients were using proton pump inhibitors (PPIs). Previous studies have indicated a similar rate of medication usage after antireflux surgery.2 The question of whether the patients received this therapy for failure of the antireflux surgery to control gastroesophageal reflux or for other reasons is answered by the finding that, when patients stopped using acid blockers, their gastroesophageal reflux symptom scores were unchanged in the surgical group and became worse in those previously receiving acid blockers without surgery. This supports the contention that many patients were receiving these medications for unconventional reasons after successful antireflux surgery. In a recent study, 14% of patients who had undergone fundoplication were found to be using PPIs for abdominal and chest symptoms, but 79% of these were using the medication for symptoms unrelated to gastroesophageal reflux.2 This indicates that physicians should rather examine their prescribing habits after antireflux surgery rather than question the efficacy of the procedure, which has repeatedly been shown to be equal to or superior to medical therapy in the control of gastroesophageal reflux and quality of life. Patients with gastroesophageal reflux are known to have associated functional bowel symptoms that will persist after antireflux surgery and generally cannot be expected to improve on antireflux medication given before or after surgery.

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