Use of proton pump inhibitors after antireflux surgery: a nationwide register-based follow-up study.
OBJECTIVE
Antireflux surgery (ARS) has been suggested as an alternative to lifelong use of proton pump inhibitors (PPI) in reflux disease. Data from clinical trials on PPI use after ARS have been conflicting. We investigated PPI use after ARS in the general Danish population using nationwide healthcare registries.


METHODS
A nationwide retrospective follow-up study of all patients aged ≥18 and undergoing first-time ARS in Denmark during 1996-2010. Two outcome measures were used: redemption of first PPI prescription after ARS (index prescription) and a marker of long-term use, defined by an average PPI use of ≥180 defined daily doses (DDDs) per year. Kaplan-Meier curves and Cox proportional hazards model were used for statistics.


RESULTS
3465 patients entered the analysis. 12.7% used no PPI in the year before surgery, while 14.2%, 13.4% and 59.7% used 1-89 DDD, 90-179 DDD and ≥180 DDD, respectively. Five-, 10- and 15-year risks of redeeming index PPI prescription were 57.5%, 72.4% and 82.6%, respectively. Similarly, 5-, 10- and 15-year risks of taking up long-term PPI use were 29.4%, 41.1% and 56.6%. Female gender, high age, ARS performed in most recent years, previous use of PPI and use of nonsteroidal anti-inflammatory drugs or antiplatelet therapy significantly increased the risk of PPI use.


CONCLUSIONS
Risk of PPI use after ARS was higher than previously reported, and more than 50% of patients became long-term PPI users 10-15 years postsurgery. Patients should be made aware that long-term PPI therapy is often necessary after ARS.
Department of Medicine, Køge University Hospital, University of Copenhagen, Køge, Denmark.
Anders
A
Lødrup
Clinical Pharmacology, Institute of Public Health, University of Southern Denmark, Odense, Denmark Department of Clinical Chemistry & Pharmacology, Odense University Hospital, Odense, Denmark.
Anton
A
Pottegård
Clinical Pharmacology, Institute of Public Health, University of Southern Denmark, Odense, Denmark Department of Clinical Chemistry & Pharmacology, Odense University Hospital, Odense, Denmark.
Jesper
J
Hallas
Department of Medicine, Køge University Hospital, University of Copenhagen, Køge, Denmark.
Peter
P
Bytzer
D000293:Adolescent; D000328:Adult; D003718:Denmark; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000188:drug therapy* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
D054328:Proton Pump Inhibitors
Anti-Reflux Surgery; Gastroesophageal Reflux Disease; Proton Pump Inhibition