Outcome of erosive reflux esophagitis after Nissen fundoplication

OBJECTIVE: The aim of this study was to compare the utilization of health c are resources and long term outcome of erosive esophagitis in patients trea ted with and without open Nissen fundoplication. METHODS: A population of 35,725 patients with erosive esophagitis was extra cted from the computerized database of the US Department of Veterans Affair s. Subjects were stratified by severity of disease into erosive esophagitis alone versus erosive esophagitis complicated by esophageal ulcers or pepti c strictures. During a mean follow-up period of 4.2 yr (range 1-12 yr), the consumption of health care resources, except for medications, was compared between case and control subjects treated with and without fundoplication, respectively. RESULTS: Among patients with complicated erosive esophagitis, 5,064 control subjects were treated without, and 542 case subjects were treated with, fu ndoplication. Cases incurred less recurrence of esophageal erosions (contro ls: 56% vs cases: 46%), esophageal ulcers (38% vs 33%), and peptic strictur es (43% vs 32%) during follow-up. Among patients with erosive esophagitis b ut no complications, 29,514 control subjects were treated without, and 605 case subjects were treated with, fundoplication. Cases did not experience a ny change in the recurrence of esophageal erosions (controls: 25% vs cases: 24%). Irrespective of treatment type, none of the case or control subjects with erosive esophagitis alone developed esophageal ulcers or peptic stric tures during follow-up. Compared with controls, how ever, after fundoplicat ion in erosive esophagitis alone, cases incurred more dysphagia (2.6% vs 4. 6%), postsurgical syndromes (0.8% vs 1.7%), as well as more outpatient visi ts (34 vs 40 visits/patient) and outpatient procedures (2.7 vs 4.3 procedur es/patient). CONCLUSIONS: Fundoplication improves the clinical outcome of erosive esopha gitis in patients with concomitant esophageal ulcers and strictures, but no t in patients without such complications. Fundoplication does not reduce th e consumption of health care resources. (Am J Gastroenterol 1999;94:1771-17 76. (C) 1999 by Am. Coll. of Gastroenterology).