113. REFLUX RECURRENCE AFTER LAPAROSCOPIC FUNDOPLICATION FOR NON-EROSIVE GASTROESOPHAGEAL REFLUX DISEASE

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Abstract Background Gastroesophageal reflux disease (GERD) is exceedingly common in high-income countries. Non-erosive GERD is increasingly being considered a different entity to erosive GERD, with a more benign disease course but less responsive to antireflux medication. Whether non-erosive GERD responds less well to antireflux surgery is unclear. We aimed to assess whether patients with non-erosive GERD retain more reflux symptoms after antireflux surgery than those with erosive GERD. Methods This was a population-based cohort study including virtually patients who underwent primary laparoscopic fundoplication for GERD in Finland or Sweden between 1996 and 2019. The exposure was non-erosive GERD, i.e., no erosive esophagitis or Barrett’s esophagus on preoperative endoscopy, which was compared to patients with erosive GERD, i.e., erosive esophagitis on preoperative endoscopy. The main outcome was reflux recurrence, defined as ≥6 months of postoperative antireflux medication or secondary antireflux surgery. Poisson regression provided hazard ratios (HR) with 95% confidence intervals (CI), adjusted for sex, age, comorbidity, hospital volume of antireflux surgery, calendar year, and country. Results Among 6194 patients who underwent primary fundoplication, 2700 (43.6%) had non-erosive GERD and 3494 (56.4%) erosive GERD. During up to 23 years of follow-up, reflux recurrence was similarly frequent in patients in the non-erosive (17.1%; n = 461) and erosive GERD (17.1%; n = 596). The overall risk of reflux recurrence was similar in non-erosive and erosive GERD (adjusted HR 1.02, 95% CI 0.90–1.15), but also when studying recurrence by medication (HR 1.04, 95% CI 0.90–1.21) and surgery (HR 0.91, 95% CI 0.75–1.10) separately. There were no differences in HRs between various follow-up categories after fundoplication or in stratified analyses. Conclusion Primary laparoscopic fundoplication seems equally effective in preventing reflux recurrence in patients with non-erosive GERD and erosive GERD.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.