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Surgery Unlikely to Douse Fires That Fuel Heartburn

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WebMD Health News
Reviewed by Gary D. Vogin, MD

May 8, 2001 -- For the millions of Americans suffering from GERD, or gastroesophageal reflux disease, a surgical fix may be no better than treatment with medications called proton pump inhibitors. In fact, surgery may increase the risk of death over time.

This year Americans are expected to spend about $5 billion to treat GERD, which occurs when acid from the stomach splashes up into the esophagus. The most common symptom of GERD is heartburn. At a time when one in five Americans complains of heartburn or acid indigestion at least once a week, surgery to correct the problem is becoming more popular, says one heartburn expert. But the operation "doesn't make reflux go away," and it doesn't reduce the risk of cancer of the esophagus, adds Stuart Jon Spechler, MD, who is a professor of medicine at the University of Texas Southwestern Medical Center at Dallas.

Worse, Spechler tells WebMD that reflux surgery may increase the risk of heart disease. These new findings are available in the May 9 issue of Journal of the American Medical Association.

The surgical fix, called a Nissen fundoplication, creates a barrier that blocks stomach acid from splashing back up into the esophagus.

When Spechler evaluated patients who had the surgery, he discovered that 40% of them died within 10-13 years of surgery, while only 28% of patients who received medical treatment died during the same follow-up period.

Spechler has been studying the two groups of patients since 1986.

"We never anticipated that there would be a difference in mortality due to heart disease, and so we had not looked into heart disease risk factors" at the beginning of the study, Spechler says. So he can only guess why the surgery patients had a higher death rate.

It is possible that "everybody who had heart disease risk factors ended up in the surgery group, but that is unlikely," he says. Possibly the surgery patients felt so good "that they smoked, drank too much, ate too much, and did everything else that can increase the risk of heart disease, or it is possible that the medications given to the medical management group have some as yet unknown benefit." Finding the answer will require more research, he says.

Spechler says that in the meantime, GERD patients and their physicians should carefully consider their options before selecting antireflux surgery because short-term benefits may disappear over time.

Often patients will opt for Nissen fundoplication because they think it will permanently "cure" heartburn and prevent the constant acid regurgitation from creating more scars on the esophagus, says Spechler. This scarring is called Barrett esophagus, a condition that is associated with an increased risk for esophageal cancer.

From 1986 to 1988 the Veterans Administration conducted a large study comparing the outcomes of GERD patients who underwent surgery to those who treated GERD with medications. Of the 247 patients who were enrolled in that study, the patients treated with surgery had significantly better outcomes after two years.

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