A population of 35,725 patients with erosive
esophagitis was extracted from the computerized database of the US Department of Veterans Affairs. Subjects were stratified by severity of disease into erosive
esophagitis alone versus erosive
esophagitis complicated by esophageal
ulcers or peptic
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,
fundoplication. Cases incurred less recurrence of esophageal erosions (controls: 56% vs cases: 46%), esophageal
ulcers (38% vs 33%), and peptic
strictures (43% vs 32%) during follow-up. Among patients with erosive
esophagitis but no complications, 29,514 control subjects were treated without, and 605 case subjects were treated with,
fundoplication. Cases did not experience any 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
strictures during follow-up. Compared with controls, however, after
fundoplication 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 visits (34 vs 40 visits/patient) and outpatient procedures (2.7 vs 4.3 procedures/patient).
CONCLUSIONS: