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Surgeon Management of PPIs Post Heller Myotomy

Andrew W White, MD, Taylor Wearda, Carl Westcott, MD. Wake Forest Baptist Hospital

Introduction:  Most patients who present for achalasia surgery are already on PPI therapy. Achalasia surgery can cause reflux and the immediate cessation of PPIs can cause rebound hyperacidity. GI and family physicians often do not understand these nuisances as they relate to post-operative PPI need.  These factors promote PPI overuse in post surgery patients. Presently, there is growing evidence that prolonged PPI therapy has significant and avoidable side effects. We examined a surgeon supervised PPI treatment course for post Heller myotomy patients.

Methods and Procedures: A retrospective chart review was performed for a single surgeon over the last four years.  We measured PPI use pre and post-operatively where the surgeon actively managed PPI use.  They were followed at 4 month intervals in the surgery clinic or by phone to determine the need for PPI and to wean as permitted. Those patients who remained on a PPI were again contacted and a weaning program initiated as symptoms allowed. 

Results:  A total of 54 patients were treated.  The average age was 57.4 years with equal distribution between male and female.  53 of 54 underwent Dor fundoplication.  62.9% of patients were on PPIs preoperatively. At the initial post-operative visit, 51.9% of patients used PPIs and 20% of patients were using a PPI BID.  17 patients were lost after the initial post-operative visit and 11 of these patients remained on a PPI.   The average follow up for all patients was 7.3 months.  At their most recent visit, 37% of patients remained on a PPI with 14.8% of patients taking a PPI BID.  15 of the 20 patients who remained on PPIs after their most recent follow up were reached by phone to attempt weaning off of PPIs.  6 were weaned successfully leaving 14 patient or 25% of patients remaining on PPIs.  These patients were given a weaning plan for discontinuing their PPIs and are being followed actively.

Conclusion: Long term follow up with a surgeon for patients undergoing Heller myotomy increases the opportunity to wean PPIs.  We were able to wean PPI use in our patient population from 51.9% at the initial post-operative visit to 25.9% at most recent contact.  We therefore believe that the patient’s surgeon is often the best suited provider for PPI management post Heller myotomy.  


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 94205

Program Number: P460

Presentation Session: Poster Session (Non CME)

Presentation Type: Poster

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