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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 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.