Surgery Beneficial for Treatment of GERD

Researchers from the University of Aberdeen (United Kingdom) recruited 810 people from 21 hospitals across the United Kingdom who had both documented evidence of GERD and symptoms of the disease for longer than 12 months. Of these, 357 patients were recruited to the randomized arm of the trial (178 allocated to surgical management, 179 allocated to continued, but optimized, medical management) and 453 were recruited to the parallel-nonrandomized preference arm (261 chose surgical management, 192 chose to continue with best medical management). The type of fundoplication was left to the discretion of the surgeon. The participants completed a baseline questionnaire developed specifically for the study, containing a disease-specific outcome measure, the Short Form with 36 Items (SF-36), the EuroQol-5 Dimensions (EQ-5D) and the Beliefs about Medicines and Surgery questionnaires (BMQ/BSQ). Postal questionnaires were completed at participant-specific time intervals after joining the trial. Intraoperative data were recorded by the surgeons and all other in-hospital data were collected by the research nurse. At the end of the study period, participants completed a discrete choice experiment questionnaire.

The results showed that surgical treatment was more effective than long-term drug therapy, especially in patients with the most troublesome symptoms. At 12 months post surgery, 38% in the randomized surgical group (14% among those who had surgery) were taking reflux medication compared with 90% in the randomized medical group. There were substantial differences favoring the randomized surgical group across the health status measures, depending on assumptions about the proportion that actually had fundoplication. Complications were uncommon and there were no deaths associated with surgery. The study was published in the September 2008 issue of Health Technology Assessment.

"Extending the use of laparoscopic fundoplication to people whose GERD symptoms require long-term medication would provide better quality of life. Like all surgery, fundoplication has some risks, but the more troublesome the symptoms, the greater the potential benefit from the operation,” said lead author Professor Adrian Grant, M.D., director of the Health Services Research Unit. "We believe that our research can help to better inform the management of patients with chronic symptoms of GERD.”

GERD, also known as gastro-oesophageal reflux disease (GORD), is defined as chronic symptoms or mucosal damage produced by the abnormal reflux in the esophagus. This is commonly due to transient or permanent changes in the barrier between the esophagus and the stomach, due to incompetence of the lower esophageal sphincter, transient lower esophageal sphincter relaxation, impaired expulsion of gastric reflux from the esophagus, or a hiatus hernia.

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University of Aberdeen