Anti-reflux surgery is a recognized option for the treatment of severe GERD disease, which reduces the use of acid preparations, avoids the need for multiple drug combinations and side effects caused by long-term use of proton pump inhibitors (PPIs), and is more favorable in terms of cost-effectiveness. However, clinical studies have also shown that the probability of still needing a PPI after anti-reflux surgery is 12-44% and is controversial in different studies. To address this phenomenon, Anders et al. from Denmark did a large Danish national study that found that more than 50% of people who underwent anti-reflux surgery still required long-term PPI use 10-15 years later, and the results were published in the journal Gut. The study utilized data from the Danish National Patient Registry, the Danish National Prescription Registry and the Danish Personal Registry databases. Adult patients who underwent anti-reflux surgery between 1996 and 2010 were selected and followed until December 2011, and the study focused on preoperative and postoperative medication use and whether to have another surgery. The study ultimately included 3465 patients, of whom 1166, 1324, and 975 had surgery between 1996-2000, 2001-2005, and 2006-2010, respectively. 2299 (66.4%) patients still required a PPI after surgery, and the cumulative risk of PPI use at 5, 10, and 15 years was 57.5%, 72.4%, and 82.6%, respectively. 72.4% and 82.6%, respectively. The cumulative risk of long-term PPI use at 5, 10, and 15 years was 29.4%, 41.1%, and 56.6% for 1335 (38.5%) patients who required long-term PPI use, respectively. 28.6% and 43.3% The main risk factors for the need for repeat and long-term PPI use were gender, age at surgery, years of surgery, preoperative PPI, NSAID and antiplatelet drug use. This population-based study found that the probability of PPI use after anti-reflux surgery was significantly higher than previously reported, with more than 50% of patients still requiring long-term PPI use 10-15 years after surgery, and that the majority of patients were on an inadequate dose of preoperative PPI. Based on the results of this study, the authors concluded that physicians need to inform patients before anti-reflux surgery that there is still a high risk of long-term PPI use after surgery, especially for those patients who undergo surgery to avoid long-term drug use. This study suggests that anti-reflux surgery may not be as effective as clinical studies have proven, but does not deny patients the benefit of the procedure, but rather suggests that patients who undergo surgery often require PPI assistance for symptom relief. In summary, the study concludes that more than half of those who undergo anti-reflux surgery still require long-term PPI use and that physicians need to carefully consider the procedure and inform patients of this risk prior to surgery.