Use of Antireflux Medication After Antireflux Surgery Bas P. L. Wijnhoven & Carolyn J. Lally & John J. Kelly & Jennifer C. Myers & David I. Watson Received: 18 July 2007 / Accepted: 19 November 2007 / Published online: 11 December 2007 # 2007 The Society for Surgery of the Alimentary Tract Abstract Introduction It is claimed that a substantial number of patients who undergo antireflux surgery use antireflux medication postoperatively. This study was aimed to determine the prevalence and underlying reasons for antireflux medication usage in patients after surgery. Materials and Methods A questionnaire on the usage of antireflux medication was sent to 1,008 patients identified from a prospective database of patients who had undergone a laparoscopic antireflux procedure. Results A total of 844 patients (84%) returned the questionnaire. Mean follow-up was 5.9 years after surgery. A single or combination of medications was being taken by 312 patients (37%): 82% proton pump inhibitors, 9% H 2 -blockers and 34% antacids. Fifty-two patients (17%) had never stopped taking medication, whereas 260 patients (83%) restarted medication at a mean of 2.5 years after surgery. Return of the same (31%) or different (49%) symptoms were the commonest reasons for taking medication, whereas 20% were asymptomatic or had other reasons for medication use. Postoperative 24-hour pH studies were abnormal in 16/61 patients (26%) on medication and in 5/78 patients (6%) not taking medication. Conclusions Antireflux medication is frequently taken by many patients for various symptoms after antireflux surgery. Symptomatic patients should be properly investigated before antireflux medications are prescribed. Keywords Medication . Gastroesophageal reflux . Fundoplication Introduction Laparoscopic antireflux surgery has shown to be effective in controlling gastroesophageal reflux. 1,2 However, it is also known that a substantial number of the patients after surgery still take antireflux medication. 3–5 One randomized-controlled trial that compared surgery with medical therapy for gastroesophageal reflux disease (GERD), reported regular usage of antireflux medication by 62% of patients 9 years after surgery, although most of the surgically treated patients were satisfied or very satisfied with the outcome of their operation. Other studies have reported lower rates of medication usage among patients after fundoplication, in the order of 15–20% after 4–5 years of follow up. 6–10 However, most patients who used acid suppressive medications after antireflux surgery did not have abnormal esophageal acid exposure. 11,12 Thus, the use of these medications often seems inappropriate, and it does not always indicate that surgical therapy has failed. Because it is currently not well-known why patients are taking medication, the type of medication they use and who prescribed the medication, we analyzed these aspects in a large cohort of patients who had undergone antireflux surgery. Materials and Methods Patients were selected from a prospective database of individuals who underwent laparoscopic antireflux proce- J Gastrointest Surg (2008) 12:510–517 DOI 10.1007/s11605-007-0443-1 B. P. L. Wijnhoven (*) : C. J. Lally : J. J. Kelly : D. I. Watson Flinders University Department of Surgery, Flinders Medical Centre, Bedford Park, South Australia 5042, Australia e-mail: bas.wijnhoven@fmc.sa.gov.au C. J. Lally : J. C. Myers University of Adelaide Discipline of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia