Esophageal dysmotility and other preoperative factors associated with acid suppressive therapy after fundoplication

• Published in: Scandinavian journal of gastroenterology 2020-01, Vol.55 (1), p.1-8
• Main Authors: Rouphael, Carol, Shakya, Sampurna, Arora, Zubin, Gabbard, Scott, Rice, Thomas, Lopez, Rocio, Raja, Siva, Murthy, Sudish, Thota, Prashanthi N.
• Format: Article
• Language: English
• Subjects: Acid suppressive therapy; collis gastroplasty; fundoplication
• ISSN: 0036-5521; 1502-7708
• DOI: 10.1080/00365521.2019.1701068

Background and aims: Acid suppressive therapy (AST) is frequently used after fundoplication. Prior studies show that most patients requiring AST after fundoplication have normal esophageal acid exposure and therefore do not need AST. Our aim was to determine the indications for AST use following fundoplication and the associated factors. Methods: Retrospective analysis of patients who underwent fundoplication at our institution between 2006 and 2013 with pre and postoperative esophageal physiologic studies was performed. Demographic data, symptoms, and findings on high resolution manometry, esophageal pH monitoring and upper endoscopy were collected. Results: Three hundred and thirty-nine patients were included with a median follow up time of 12.8[2.6, 47.7] months. Mean age was 59.6 ± 13.3 years and 71.4% were women. Of those, 39.5% went on AST following fundoplication with a median time to AST use of 15.7[2.8, 36.1] months. The most common reason for AST use was heartburn. Only 29% of patients had objective evidence of acid reflux. Preoperative factors associated with AST use following fundoplication were male gender (HR1.6, p = 0.019), esophageal dysmotility (HR1.7, p = 0.004), proton pump inhibitor use (HR2.3, p