Department of Medicine, Køge University Hospital, University of Copenhagen, Køge, Denmark.
Clinical Pharmacology, Institute of Public Health, University of Southern Denmark, Odense, Denmark Department of Clinical Chemistry & Pharmacology, Odense University Hospital, Odense, Denmark.
Gut. 2014 Oct;63(10):1544-9. doi: 10.1136/gutjnl-2013-306532. Epub 2014 Jan 28.
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.
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.
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.
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.
抗反流手术（ARS）已被提议作为反流病患者终身使用质子泵抑制剂（PPI）的替代方案。关于 ARS 后 PPI 使用的临床试验数据一直存在争议。我们使用全国性的医疗保健登记处调查了丹麦普通人群中 ARS 后的 PPI 使用情况。
这是一项针对丹麦所有 1996-2010 年首次接受 ARS 的年龄≥18 岁的患者的全国性回顾性随访研究。使用了两种结果测量方法：ARS 后的首次 PPI 处方（索引处方）的兑现和长期使用的标志，定义为每年平均 PPI 使用量≥180 个定义日剂量（DDD）。使用 Kaplan-Meier 曲线和 Cox 比例风险模型进行统计分析。
3465 名患者进入分析。12.7%的患者在手术前一年没有使用 PPI，而分别有 14.2%、13.4%和 59.7%的患者使用了 1-89 DDD、90-179 DDD 和≥180 DDD。兑现索引 PPI 处方的 5、10 和 15 年风险分别为 57.5%、72.4%和 82.6%。同样，开始长期使用 PPI 的 5、10 和 15 年风险分别为 29.4%、41.1%和 56.6%。女性、高龄、最近几年进行的 ARS、以前使用 PPI 以及使用非甾体抗炎药或抗血小板治疗显著增加了 PPI 使用的风险。
ARS 后 PPI 使用的风险高于先前报道，超过 50%的患者在手术后 10-15 年内成为长期 PPI 用户。应让患者意识到 ARS 后通常需要长期 PPI 治疗。
