Outcome of antireflux surgery in community

Gastroesophageal reflux disease (GERD) is a common problem. The disease may or may not cause damage to the esophagus, i.e. erosive versus non-erosive reflux disease. There has been an ongoing debate whether the medical or surgical treatment is superior. Most of the data about the outcome of surgery comes from tertiary care referral centers where the surgeons may be doing these operations more frequently than their counterparts in the community practice.

Antireflux surgery has been mainly evaluated in tertiary referral centers. There is paucity of data regarding the outcome of antireflux surgery performed in community practice. Dr. Thibault and colleagues from University Hospital in Nantes (France) studied this issue and published their findings in the Alimentary Pharmacology and Therapeutics (August 2006).

These investigators studied 60 non-erosive reflux disease (NERD) and 61 erosive esophagitis patients. They measured the disease-specific health-related quality of life, symptoms, late morbidity and use of medications. The outcome was assessed at a median period of 43 months after surgery.

The authors found that less than two-thirds of the patients reported excellent outcome, which is in contrast to much higher results from major referral centers. Non-erosive reflux disease group patients reported lower quality of life scores. These patients were also more symptomatic.

In addition to the expertise of the surgeon, patients were likely to have better outcome if they were males, had abnormal esophageal acid exposure prior to surgery and long duration of symptoms.

The investigators concluded that the results of the antireflux surgery by community surgeons are inferior to those reported by tertiary centers. NERD patients have poorer outcome as compared to those with erosive disease.

Almost one-third of patients with non-erosive reflux disease in this study continued to take proton-pump inhibitors. This number however is much lower than that reported by us and other investigators. The investigators stressed the importance of careful selection of patients before antireflux surgery.