TY - JOUR
AU - Hassn, A
AB - Abstract The Editors welcome topical correspondence from readers relating to articles published in the Journal. Responses should be sent electronically via the BJS website (www.bjs.co.uk). All letters will be reviewed and, if approved, appear on the website. A selection of these will be edited and published in the Journal. Letters must be no more than 250 words in length. Sir We read with interest the recent leading article in which the authors have indicated that the role of antireflux surgery for gastro-oesophageal reflux disease (GORD) is marginal and reserved only for patients who are either unwilling to take drugs or whose condition is refractory to such treatment. Although we agree with these two indications for surgery we believe that the role of surgery is not marginal. On the contrary, surgery offers a great deal more in a number of different clinical situations. Surgery should be considered in young patients who are completely dependent on high-dose proton-pump inhibitor (PPI) therapy and in whom lifelong PPIs are often required to control symptoms1. In addition to age, consideration should be given to general fitness and co-morbidity2. Patients on long-term acid suppression (10, 20 or even 30 years) are at risk of suffering intolerable side-effects and adverse drug interactions3,4, not least because of an absolute reduction in gastric acid. Theoretically, this can lead to an increase in the risk of gastric cancer. Furthermore, some patients still experience the unpleasant symptoms of regurgitation in the form of chronic cough and recurrent chest infections despite zealously following long-term PPI therapy. Lastly, the natural history of GORD is a gradual disease progression in many patients with or without acid suppression and it is prudent to counsel patients for surgery who are dependent on high-dose PPIs for more than 12 months. References 1 Vassiliou MC , von Renteln D, Rothstein RI. Recent advances in endoscopic antireflux techniques . Gastrointest Endosc Clin N Am 2010 ; 20 : 89 – 101 . Google Scholar Crossref Search ADS PubMed WorldCat 2 Liakakos T , Karamanolis G, Patapis P, Misiakos EP. Gastroesophageal reflux disease: medical or surgical treatment? Gastroenterol Res Pract 2009 ; 37 : 1580 . Google Scholar OpenURL Placeholder Text WorldCat 3 Last EJ , Sheehan AH. Review of recent evidence: potential interaction between clopidogrel and proton pump inhibitors . Am J Health Syst Pharm 2009 ; 66 : 2117 – 2122 . Google Scholar Crossref Search ADS PubMed WorldCat 4 Altman KW , Radosevich JA. Unexpected consequences of proton pump inhibitor use . Otolaryneal Head Neck Surg 2009 ; 141 : 564 – 566 . Google Scholar Crossref Search ADS WorldCat Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
TI - Surgical management of refractory gastro-oesophageal reflux (Br J Surg 2010; 97: 139–140)
JO - British Journal of Surgery
DO - 10.1002/bjs.7205
DA - 2010-07-05
UR - https://www.deepdyve.com/lp/oxford-university-press/surgical-management-of-refractory-gastro-oesophageal-reflux-br-j-surg-30LHRela4z
SP - 1309
EP - 1309
VL - 97
IS - 8
DP - DeepDyve
ER -