GERD Surgery - No Good?
Medical Editor: Dennis Lee, M.D.
A while back, the newspapers were trumpeting the story implying that surgery for gastro-esophageal reflux disease (GERD) was not as good as treatment with medication. The story was based on a study that evaluated a group of patients years after they participated in a study comparing the medical and surgical treatments of GERD. The study was published in the Journal of the American Medical Association.
The original study had been carried out from 1986 through 1988 in several veterans administration hospitals. Patients with severe GERD had been randomly selected to be treated with either medication or anti-reflux surgery (fundoplication). It was a reasonably large study (243 patients) that involved primarily men. (There were only 4 women.) The study followed the patients for two years after their selection to either surgery or medication. The 2-year study demonstrated that surgery was superior to medication, resulting in better control of symptoms, a need for less medication, and less cost overall.
The new study identified as many as possible of the original patients in the study to see how they were doing approximately eight years after the old study had ended. Not surprisingly, the new study found that more patients treated with medication were consuming medications for GERD than patients treated with surgery. However, a large number of the surgically-treated patient -- 62% -- were also taking medications. The authors interpreted this to mean that surgery was not effective in preventing the need for medication. The authors of the new study concluded that surgery should not be recommended with the expectation that it would prevent the need for further treatment with medication. The implication of the study-though the authors were careful to avoid the implication--was that surgery was ineffective at relieving the symptoms of GERD in the long-run.