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Surgical fundoplication use in GERD patients significantly declines
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Use of surgical fundoplication in patients with GERD has rapidly declined in the U.S. between 2009 and 2013, according to the results of a national population-based study.
“Recent years have seen several changes in the therapeutic landscape of GERD. There is a marked decline in the development of new medical therapeutic modalities, but a significant increase in the development of nonmedical (endoscopic and surgical) techniques,” Ronnie Fass, MD, of The Esophageal and Swallowing Center, division of gastroenterology and hepatology, MetroHealth Medical Center, Case Western Reserve University in Cleveland, Ohio, and colleagues wrote. “There has also been growing recognition of the important limitations of surgical fundoplication for providing patients with an effective, safe long-term solution.”
Fass and colleagues therefore sought to ascertain trends in surgical fundoplication use among GERD patients over the last decade. Using a large nationwide database (Explorys), they identified 4,059,060 patients with GERD, 0.05% of whom underwent surgical fundoplication between 2004 and 2013.
between 2009 (0.062%) and 2013 (0.047%; P < .05).
“Overall, there was a 48.8% increase in the utilization rate of surgical fundoplication from 2004 to 2009. However, there was a 23% decline in the utilization rate of surgical fundoplication from 2009 to 2013,” the researchers wrote.”
Most patients who underwent surgical fundoplication were women (62.5%), white (77.67%) and aged 18 to 65 years (66.28%). Moreover, the number of overweight patients who underwent surgical fundoplication has increased significantly over the last decade (P = .003).
They also observed a significant increase in PPI use over the last decade (P < .001), and 80% of patients who underwent surgical fundoplication received PPIs after surgery by the end of the study period (P < .001).
“The exact reason for the decline in utilization of surgical fundoplication, as well as the increase in consumption of anti-reflux medications post surgery, remains to be fully elucidated,” the researchers concluded. “Importantly, it is possible that future improvements in medical and endoscopic therapeutic modalities will result in a further decline in surgical fundoplication, potentially further limiting its utilization.” – by Adam Leitenberger
Disclosure: Fass reports he is a consultant for Mederi Therapeutics, Pfizer, Medtronic and Torax, a speaker for Takeda, Dr Reddy’s, Mederi Therapeutics and AstraZeneca, and receives research funding from Evoke Pharmaceuticals.
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