Certain Drugs May Be as Effective as Surgical Management for GERD

A Comparative Effectiveness Review from the Agency for Healthcare Research and Quality (AHRQ) found that medical management with certain drugs is as effective as surgical management for chronic uncomplicated gastroesophageal reflux disease (GERD). The Tufts–New England Medical Center Evidence-based Practice Center prepared this report under contract with AHRQ.

“As the first Comparative Effectiveness Review, this report opens a new and promising chapter for helping patients choose the best evidence-based treatment for their own situation,” AHRQ Director Carolyn M. Clancy, MD, said in a news release. “Today’s report will help patients and health care providers make more informed choices when they consider how to manage the symptoms of chronic GERD, and especially when they consider surgery.”

GERD, defined as weekly heartburn and/or acid regurgitation, is one of the most prevalent health conditions in older Americans, resulting in $10 billion annually in direct healthcare costs in the United States in 2000. For chronic GERD, defined as frequent, severe symptoms requiring long-term, regular use of antireflux medications, treatment goals are improvement in symptoms and quality of life, healing and maintenance of healed erosive esophagitis, and prevention of complications, such as Barrett esophagus, esophageal stricture formation, or esophageal adenocarcinoma.

Evidence reviewed in the report suggests that for most patients with uncomplicated GERD, proton pump inhibitors (PPIs) can be as effective as surgery in relieving symptoms and improving quality of life.

Although one of the indications for surgery may be to alleviate the need for pharmacotherapy, the evidence does not conclusively show that a significant proportion of patients undergoing surgery can eventually stop their medications. In the studies reviewed in this report, 10% to 65% of patients treated surgically resumed medication use.

“While advocates of surgery continue to suggest that it might be more effective than medical therapy for prevention of Barrett’s esophagus and esophageal cancer, evidence supporting this assertion has been inconclusive,” the authors write. “A challenge in treating GERD is that neither improvement in symptoms nor reduction in the need for antisecretory medications has consistently correlated with objective measures such as normalization of esophageal pH exposure or healing of esophagitis. The endoscopic approaches, in particular, have drawn into focus the disparities that can exist among various objectives in treating GERD.”