March 13, 2003 -- Millions of Americans suffer from acid reflux disease and while many treat it with drugs, others have turned to surgery to put out the flames. Now new research finds the two approaches may work equally well in preventing a rare but deadly consequence of chronic heartburn -- cancer of the esophagus.
Spanish researchers evaluated 101 people with acid reflux disease -- known medically as gastroesophageal reflux disease or GERD. Each person had a complication of acid reflux known as Barrett's esophagus -- which occurs in about 10% of people with GERD -- in which cells in the esophagus become abnormal due to persistent acid exposure. Up to 0.5% of people with Barrett's esophagus develop cancer of the esophagus each year.
(For more information on untreated acid reflux disease and Barrett's esophagus, read this in-depth article from WebMD and The Cleveland Clinic.)
Each participant in the study was treated with either medication or surgery and then followed for five years. Preliminary studies have suggested that surgery may be more effective than medication to prevent GERD from progressing to cancer, but surgery for Barrett's esophagus is still controversial.
Both treatments offered excellent to good symptom relief in more than 90% of patients. And the researchers found no significant difference between the two treatments in preventing the progression to cancer.
Those who had successful surgery developed fewer cancers than those who took strong acid blockers but 15% of surgeries were considered unsuccessful. The findings are reported in the March 2003 issue of the journal Annals of Surgery.
In an editorial accompanying the study, surgeon Jeffrey H. Peters, MD, writes that this study offers more evidence that effectively controlling acid reflux disease -- either with surgery or medications -- can help prevent esophageal cancer.
Failures of both types of treatment can almost always be identified and corrected, according to Peters. And since good control of acid reflux disease appears to prevent cancer, we should be able to significantly decrease cancer of the esophagus, one of the most lethal tumors in human disease, he adds.
Esophageal specialist Yvonne Romero, MD, of the Mayo Clinic, tells WebMD that, all things being equal, she prefers medication to surgery for the treatment of GERD and Barrett's esophagus. Studies from the U.S. routinely find that surgery is successful in approximately 90% of patients. But reports from other countries, where acid reflux surgery has been performed longer, paint a bleak picture of long-term outcome, she says. Findings from Brazil, for example, suggest that 50% of patients experience surgical failure 10 years after surgery, as characterized by a return in acid reflux disease symptoms, and surgical failure occurs in 85% of patients after 15 years.
In addition, one in five patients may develop trouble swallowing, either immediately after surgery or as long as several years later, she says. This complication can result in more surgery to fix the problem.
While GERD and Barrett's esophagus are the biggest risk factors for esophageal cancer, Romero points out the risk is still quite small for patients with these conditions. She adds that some 40% of people who do develop cancer of the esophagus have no history of acid reflux disease or heartburn.
"The truth is this is a pretty rare cancer that occurs in just three or four people out of 100,000," she says. "But that doesn't mean you can ignore these symptoms."
Is surgery for acid reflux disease right for you? This article might help you and your doctor make the decision between medication and surgery.