Long-Term Comparison of Antireflux Surgery Versus Conservative Therapy for Reflux Esophagitis

Abstract

ObjectiveThe purpose of the study was to evaluate the long-term symptomatic and endoscopic outcome in gastroesophageal reflux disease with erosive esophagitis, comparing conservative with operative management. MethodsThe study comprised 105 of 120 patients consecutively referred for severe reflux symptoms to the gastroenterologic outpatient department of a teaching hospital, where erosive esophagitis was confirmed endoscopically. If conservative management (modified lifestyle and medication) failed to relieve symptoms and heal the esophagitis, antireflux surgery (Nissen fundoplication) was undertaken. 10.9 years) evaluation of all patients included comprehensive, standardized interviews; self-scoring of symptoms at the time of referral and currently; and observations at endoscopy. ResultsNissen fundoplication was performed on 37 of the 105 patients. At follow-up of these 37 patients, (31) 84% had no or only occasional mild heartburn, (33) 89% were free from erosive esophagitis, and (2) 5% were taking H2 antagonists or omeprazole. The corresponding figures in the 68 patients with only conservative treatment were (36) 53%, (31) 45%, and (14) 21 %. The mean change in symptom score between referral time and follow-up was 5.7 in the surgically treated group and 1.7 in the nonsurgically treated group. Fifteen new cases of Barrett's metaplasia were found at follow-up. ConclusionsIn gastroesophageal reflux disease with erosive esophagitis, surgical treatment gave results subjectively and objectively superior to those from conservative management. 295

The myth of the short esophagus

“…With such a large prevalence, surgeons are constantly trying to improve the techniques and procedures used to treat this disease. Most authors agree that antireflux surgery is a better option than medical therapy for severe or complicated GERD [20,37]. The ability to perform laparoscopic antireflux procedures has led to the resurgence of surgical treatment of GERD.…”

Medical and Surgical Evaluation of Barrett’s Esophagus and Barrett’s Cancer

“…In a long-term (median 10.9 years) follow-up study Isolauri et al [13] observed that 11.1% of the patients with medically treated GERD and 18.9% of the surgically treated patients developed new Barrett's mucosa. Wetscher et al [14] described an extremely high incidence (33.8%) of new Barrett's metaplasia in GERD patients, despite intermittent or continuous antisecretory medication.…”

Symptom-focused results after laparoscopic fundoplication for refractory gastroesophageal reflux disease—a prospective study

“…Several reports have shown laparoscopic Nissen fundoplication to be an established treatment option for chronic GERD [8,[12][13][14][15]. The use of antireflux surgery in patients with persistent symptoms despite therapy with PPIs has been discouraged because of the evidence that positive response to medical therapy is predictive of surgical success [9,16,17].…”