The performance and durability of various types of fundoplication is variable when stratified by disease severity. To date, magnetic sphincter augmentation (MSA) has not been evaluated in this context. We designed the current study to determine the efficacy of MSA in the treatment of severe GERD.
Guided by previous studies, a DeMeester score (DMS)≥50 was used as a cutoff point to define severe reflux disease. Subjects were divided into two groups using this cutoff and outcomes of severe cases were compared to those with less severe disease (DMS<50).
A total of 334 patients underwent MSA. Patients with severe disease had a higher mean preoperative DMS compared to those with mild-moderate GERD [79.2(53.2) vs. 22.8(13.7), p<0.0001]. At a mean postoperative follow-up of 13.6 (10.4) months, there was no difference between the GERD-HRQL total scores in patients with severe disease compared to those with less severe GERD [8.8(10) vs. 9.2(10.8), p=0.9204]. Postoperative DMS was not different between groups [17.3(23.0) vs. 14.1(33.9), p=0.71], and there was no difference in the prevalence of esophagitis (p=0.52). Patients with severe disease were less likely to be free from use of PPI after surgery (85% vs. 93.1%, p=0.041). There were similar rates of postoperative dysphagia (10% vs. 14%, p= 0.42) and need for device removal (3% vs. 5%, p=0.7463).
MSA is an effective treatment in patients with severe GERD and leads to significant clinical improvement across the spectrum of disease severity with few objective outcomes being superior in patients with mild-moderate reflux disease.

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