Use of acid-suppressive therapy before anti-reflux surgery in 2922 patients: a nationwide register-based study in Denmark.
BACKGROUND
Guidelines recommend that patients with gastro-oesophageal reflux disease are adequately treated with acid-suppressive therapy before undergoing anti-reflux surgery. Little is known of the use of acid-suppressive drugs before anti-reflux surgery.


OBJECTIVE
To determine the use of proton pump inhibitors and H2 -receptor antagonists in the year before anti-reflux surgery.


METHODS
A nationwide retrospective study of all patients aged ≥18 undergoing first-time anti-reflux surgery in Denmark during 2000-2012 using data from three different sources: the Danish National Register of Patients, the Danish National Prescription Register, and the Danish Person Register.


RESULTS
The study population thus included 2922 patients (median age: 48 years, 55.7% male). The annual proportion of patients redeeming ≥180 DDD of acid-suppressive therapy increased from 17.0% 5 years before anti-reflux surgery to 64.9% 1 year before. The probability for inadequate dosing 1 year before surgery (<180 DDD) was significantly increased for younger patients, patients operated in the period 2000-2003, patients who had not undergone pre-surgical manometry, pH- or impedance monitoring, and patients who had not redeemed prescriptions on NSAID or anti-platelet drugs.


CONCLUSIONS
Compliance with medical therapy should be evaluated thoroughly before planning anti-reflux surgery, as a high proportion of patients receive inadequate dosing of acid-suppressive therapy prior to the operation.
Department of Medicine, Køge University Hospital, Køge, Denmark.|Diagnostic Center, Silkeborg Hospital, Silkeborg, Denmark.
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Lødrup
Clinical Pharmacology, Department of Public Health, University of Southern Denmark, Odense, Denmark.
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Pottegård
Clinical Pharmacology, Department of Public Health, University of Southern Denmark, Odense, Denmark.|Department of Clinical Chemistry & Pharmacology, Odense University Hospital, Odense, Denmark.
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Hallas
Department of Medicine, Køge University Hospital, Køge, Denmark.|Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark.
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Bytzer
D000328:Adult; D003718:Denmark; D017097:Electric Impedance; D005260:Female; D005764:Gastroesophageal Reflux / Q000188:drug therapy* / Q000601:surgery; D006635:Histamine H2 Antagonists / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies
D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors