Stomach Wraps Effective in Treating Severe Acid Reflux

Fundoplication may be more helpful than acid suppression tablets in the short to medium term treatment of severe gastro-esophageal reflux disease (GERD), according to a new study.

Researchers at the University of Aberdeen (United Kingdom) searched databases dating from 1966, conference abstracts, and reference lists from published trials, and contacted experts in the field for further unpublished material regarding trials comparing medical management of GERD with laparoscopic fundoplication surgery. Two authors then independently extracted data from articles identified for inclusion, and assessed the methodological quality of eligible trials. The primary outcomes were health-related and GERD-specific quality of life (QOL), heartburn, regurgitation, and dysphagia. In all, four trials were included with a total of 1,232 randomized participants.

The results showed that there were statistically significant improvements in health-related QOL at three months and one year after surgery, compared to medical therapy. All four studies reported significant improvements in GERD-specific QOL after surgery compared to medical therapy, although data were not combined. The researchers found evidence to suggest that symptoms of heartburn, reflux, and bloating are improved after surgery compared to medical therapy, but a small proportion of participants have persistent postoperative dysphagia. Overall rates of postoperative complications were low, but surgery was not without risk and postoperative adverse events occurred, although they were uncommon. The costs of surgery were found to be considerably higher than the cost of medical management, although the data are based on the first year of treatment, and therefore the cost and side effects associated with long-term treatment of chronic GERD need to be considered. The study was published on March 17, 2010, in the Cochrane Database of Systematic Reviews.

"Previous research, prior to the development of keyhole surgery for GERD, has suggested that the benefits of surgery for GERD are not sustained over time, highlighting the importance for future keyhole fundoplication studies to include longer term follow-up,” said lead author Samantha Wileman, M.D., of the health services research unit. "We also need to know more about the clinical and cost implications of long term medication versus surgery.”

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