Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor
To the Editor: Dr Spechler and colleagues1 found that many patients take antireflux medications
following antireflux surgery. We recently reported on 86 patients who underwent
24-hour distal esophageal pH monitoring to investigate symptoms after Nissen
fundoplication.2 Although all these patients
had symptoms that were severe enough to prompt both medical consultation and
the performance of a prolonged pH monitoring study, and although 43% of them
had taken acid suppressant medications after surgery, the pH monitoring study
showed that only 20 (23%) patients had abnormal distal esophageal acid exposure.
Furthermore, only 24% of the patients who had used acid suppressant medications
after surgery had abnormal acid exposure. Acid suppressant medication use
is thus likely to have been inappropriate for many or most of the patients
in our study. Patients who had used these medications were statistically no
more likely to have recurrent or persistent reflux disease after surgery than
patients who did not use the drugs. We also found that symptoms reported after
Nissen fundoplication were not a reliable guide to the presence of abnormal
gastroesophageal reflux, indicating that objective evidence of GERD should
be obtained before acid suppressant medications are prescribed for patients
who have undergone antireflux surgery.
Lord RVN, Öberg S. Medical vs Surgical Treatment of Gastroesophageal Reflux. JAMA. 2001;286(14):1709–1712. doi:10.1001/jama.286.14.1709
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