Antireflux surgery for non-erosive and erosive reflux disease in community practice.
BACKGROUND
Antireflux surgery has been mainly evaluated in tertiary referral centres. Data regarding post-operative outcome in non-erosive reflux disease are lacking.


OBJECTIVE
To assess long-term outcome after antireflux surgery performed in a community practice setting.


METHODS
We selected consecutively 60 non-erosive reflux disease patients and 61 erosive oesophagitis patients with symptomatic gastro-oesophageal reflux disease. After surgery, each subject answered a validated disease-specific health-related quality of life questionnaire and another questionnaire focusing on symptoms, late morbidity and drug use.


RESULTS
After a 43-month median follow-up, an excellent outcome was reported by less than two-thirds of patients. Quality of life scores were lower in the non-erosive reflux disease group, especially in female patients. Non-erosive reflux disease patients reported more daily symptoms and more reflux-related symptoms (P = 0.04). Proton-pump inhibitor use was higher in non-erosive reflux disease patients (P < 0.005). Multivariate analysis identified four independent predictive factors associated with better outcome, namely male gender, abnormal preoperative acid exposure, a long duration of symptoms and surgical expertise.


CONCLUSIONS
In community practice, the results of antireflux surgery are inferior to those reported by tertiary centres. Outcome seems poorer in non-erosive reflux disease especially in female patients. Nearly one-third of the non-erosive reflux disease patients continue to take proton-pump inhibitors. These results highlight the need for careful selection of patients before antireflux surgery.
Thibault
R
R
Department of Gastroenterology, Hepatology and Nutritional Support, Institut des Maladies de l'Appareil Digestif, University Hospital, Nantes, France.
Coron
E
E
Sébille
V
V
Sacher-Huvelin
S
S
Bruley des Varannes
S
S
Gournay
J
J
Galmiche
J P
JP
D000863:Antacids / Q000627:therapeutic use; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D011788:Quality of Life; D016896:Treatment Outcome
D000863:Antacids; D006635:Histamine H2 Antagonists