Medical versus surgical management for gastro-oesophageal reflux disease (GORD) in adults

“…However, surgery is associated with a risk of morbidity. Whether the benefits of surgery sustain on the long term remains uncertain due to conflicting data [21].…”

Section: Introductionmentioning

confidence: 99%

Long-term follow up in patients with gastroesophageal reflux disease with specific emphasis on reflux symptoms, use of anti-reflux medication and anti-reflux surgery outcome: a retrospective study

Meer

Bogte

Siersema

2013

Scandinavian Journal of Gastroenterology

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“…the success rate is considerably higher, then the damage is potentially even greater. Sandbu et al have previously asked for randomized trials to answer the question whether LARS or medical treatment should be preferred and these studies have to a certain degree now been performed and also analyzed in a recent Cochrane review [5]. LARS is concluded, in the short and medium term, to be more effective than medical management but the long-term benefits of surgery remains uncertain due to lacking available data at hand today.…”

Section: Sirmentioning

confidence: 99%

Comment on: Nationwide survey of long-term results of laparoscopic antireflux surgery in Sweden

Dalenbäck

2010

Scandinavian Journal of Gastroenterology

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“…No generally accepted definition of PPI refractoriness is currently available [1,3], and according to the surgical antireflux literature, there seems to be no efforts to find a suitable definition and reach a consensus on what is meant by refractoriness to medical therapy. This is problematic since the only grade A evidence that we have on the efficacy of LF as compared to modern medical therapy comes from studies in which responsiveness to chronic PPI therapy was an inclusion criterion [4,5,6,7,8]. …”

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confidence: 99%

“…Occasionally, weakly acidic or nonacidic reflux causes persistent symptoms under PPIs and can be detected with impedance monitoring [1]. Clinical follow-up data have shown that patients with such symptoms can have a successful outcome with Nissen fundoplication [7]. There is a further group of patients whose refractory symptoms are due to unusual sensitivity to a normal amount of acid in the esophagus.…”

mentioning

confidence: 99%

Borderline Indications and Selection of Gastroesophageal Reflux Disease Patients: ‘Is Surgery Better than Medical Therapy'?

Lundell

2014

Dig Dis

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Modern medical therapies for gastroesophageal reflux disease (GERD) are totally dedicated to the control of the acid component of the refluxate. In chronic erosive GERD, antireflux surgery has proven to be very efficacious and superior to traditional medical therapies, such as H₂ blockers. The introduction of proton pump inhibitors (PPIs), however, substantially improved medical therapy. Still, treatment failures are inevitable regardless of which of these two effective therapies is chosen. Some recent reports have presented conflicting results from trials comparing antireflux surgery and PPIs. This may be due to differences in trial designs as well as in the structure and content of the therapeutic strategies that are compared. The study with the longest clinical follow-up by far is the SOPRAN study comparing open antireflux surgery and omeprazole. The protocol provides for a follow-up period of more than a decade and the clinical outcomes have recently been published. There has always been concern about the long-term effectiveness of reflux prevention whether by surgery or PPI therapy. It is likely that a marker for an emerging risk for recurrence of GERD is abnormal acid reflux as assessed by ambulatory 24-hour pH-metry. The LOTUS trial compared maintenance therapy provided by esomeprazole (dose-adjusted when required) with standardized laparoscopic antireflux surgery in patients with good response to acid suppressive therapy. An operation is suitable when symptoms are poorly controlled despite medication, especially for patients who suffer large-volume regurgitation and those who wake at night coughing and choking and who regurgitate acidic fluid or food into their throat and airways. Regurgitation into the throat upon stooping or exercising can limit a patient's ability to work, play sports or even do simple housework. A few patients cannot tolerate medical treatment. If surgery is to be a good option, it must be ensured that the right surgeon performs a standardized operation for the right indications on the right patient and provides good preoperative counseling and testing along with postoperative support. When a patient is refractory to medical treatment, the diagnosis of GERD should be reconsidered before surgery is advised; extradigestive manifestations should be accounted for with care. Conclusions: Laparoscopic fundoplication (LF) substantially improves GERD symptoms, although in some individuals symptoms return and acid-suppressive medication use increases. Limited data suggest that LF is less effective at reducing symptoms in partial responders to medical therapy than in complete responders. This may affect cost arguments for using fundoplication surgery rather than acid-suppressive medications, as data are based largely on complete responders.

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Medical versus surgical management for gastro-oesophageal reflux disease (GORD) in adults

Cited by 96 publications

References 22 publications

Long-term follow up in patients with gastroesophageal reflux disease with specific emphasis on reflux symptoms, use of anti-reflux medication and anti-reflux surgery outcome: a retrospective study

Long-term follow up in patients with gastroesophageal reflux disease with specific emphasis on reflux symptoms, use of anti-reflux medication and anti-reflux surgery outcome: a retrospective study

Comment on: Nationwide survey of long-term results of laparoscopic antireflux surgery in Sweden

Borderline Indications and Selection of Gastroesophageal Reflux Disease Patients: ‘Is Surgery Better than Medical Therapy'?

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