National rates of laparoscopic antireflux surgery grew steadily in the 1990s.
Since then, a highly visible randomized trial has questioned the long-term effectiveness of antireflux surgery.
Several new endoscopic therapies have been developed, and proton pump inhibitors have become available over the counter.
Whether these recent developments have had an impact on the use of antireflux surgery remains unknown.
|Surgical rates fell by about 30% by 2003|
Dr Jonathan Finks and colleagues from Michigan identified all patients over 18 years who underwent antireflux surgery between 1994 and 2003.
The researchers used data from the Nationwide Inpatient Sample.
The research team used sampling weights to estimate the total number of procedures performed in the United States each year.
Population-based rates were determined using denominators from US census data.
The researchers found that the annual number of antireflux procedures grew rapidly during the 1990s, peaking at 31,695 in 1999.
After 1999, the team observed that surgical rates declined steadily, falling approximately 30% by 2003 to 23,998.
Use of antireflux procedures fell more precipitously among younger patients, and at teaching hospitals.
The researchers noted that the proportion of cases managed laparoscopically remained stable after 1999.
Dr Finks' team concludes, “The use of antireflux surgery in the United States has declined substantially.”
“Although other factors may be involved, this trend may reflect new questions about the long-term effectiveness of surgery and suggests the need for prospective randomized clinical trials assessing current therapies.”