Reflux Surgery May Not End Need for Medication

A 10-year follow-up study on 239 patients with complicated gastroesophageal reflux disease (GERD) who had participated in an earlier trial of medical versus surgical antireflux treatments has found that more than half of the surgery patients used antireflux medications regularly. The follow-up study, conducted by researchers at various U.S. Department of Veterans Affairs Medical Centers, was published in The Journal of the American Medical Association (JAMA, 2001;285:2331-2338).

The initial study suggested that surgery was the best treatment for GERD. The advantages of surgery were assumed to be permanent relief, elimination of the need for antireflux mediations, and prevention of cancer. The follow-up study found none of these benefits. Specifically, 92% of the medical patients and 62% of the surgical patients reported regular use of antireflux medications. No statistical difference between medical and surgery patients was found in the occurrence of esophageal cancer. Also, a number of patients in both groups had one or more antireflux operations (10% of medical patients and 16% of surgical patients.)

As a result, the researchers suggest that doctors should advise patients with GERD that surgery may not eliminate the need for medication and that the procedure will not prevent cancer of the esophagus or the need for another operation. One finding that the researchers could not explain was that about 40% of the surgery group but only 28% of the medical group died. Nearly half of the surgery patient deaths were from heart attacks. The researchers suggest that doctors tell GERD patients who have surgery to make an extra effort to control their risk factors for heart disease.