Similar liver transplantation survival with selected cardiac death donors and brain death donors (Br J Surg 2010; 97: 744–753)

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Abstract

SirWe 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 symptoms 1 .In addition to age, consideration should be given to general fitness and co-morbidity 2 .Patients on long-term acid suppression (10, 20 or even 30 years) are at risk of suffering intolerable side-effects and adverse drug interactions 3,4 , 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.

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