Medication, Surgery Both Treat Acid Reflux Well
Study: Many GERD Patients Get Relief From Either Treatment
Medication or Surgery for GERD? continued...
Before they split the patients into treatment groups, researchers gave all participants 40 milligrams of Nexium daily for three months to test their response to the drug.
Those that reported relief of their symptoms were randomly assigned to receive either 20 milligrams of Nexium once daily -- a dose that could be increased to 40 milligrams a day if their symptoms came back -- or lapraroscopic surgery that treats acid reflux by tightening a loose muscle that acts like a valve at the top of the stomach.
“They basically pull the top of the stomach around the esophagus, so they are tightening the sphincter,” says Mouen Khashab, MD, assistant professor of medicine and director of therapeutic endoscopy at Johns Hopkins University in Baltimore.
Five years later, 92% of the 266 people in the study who were taking the Nexium, and 85% of the 288 people in the surgery group, continued to have either no symptoms or bearable reflux symptoms.
The main differences between the groups were that patients taking medication continued to experience mild GERD symptoms, including regurgitation, heartburn, and abdominal pain.
Study participants who’d had the surgery, on the other hand, reported more complete resolution of those symptoms, but more difficulty swallowing and trouble belching, a problem that can lead to bloating.
Those are differences that may be meaningful to patients who are choosing one treatment over the other, experts say.
In reading the study, Walter W. Chan, MD, MPH, an instructor of medicine at Harvard Medical School and a gastroenterologist at Brigham and Women’s Hospital in Boston, says it seemed to him like the surgical patients had better resolution of their symptoms.
“I think it’s a well-done, well-designed study. I just don’t think that you can draw the conclusion that taking medication one or two times a day is just as good as undergoing surgery,” he tells WebMD.
And Chan notes that there have been concerns about the safety of proton pump inhibitors when they are taken long-term. Some studies have suggested they may increase the risk of fractures and infections, for example.
Other experts noted that the surgical results achieved in the study depend on finding an experienced surgeon and having the procedure done at a medical center that does many of them.
“It generally works very well if you chose the patients correctly and send the patients to the right surgeon,” says Khashab.
But the procedure does have risks, he says. In some cases, the repair may be too tight and gas can’t escape from the stomach, a problem called gas-bloat syndrome. Patients may also experience difficulty getting food to go down into the stomach, or dysphagia. Those problems can be corrected with a revision procedure.