Anti-reflux Surgery More Effective Than Medication
According to a study led by researchers at the University of Aberdeen, anti-reflux surgery is more effective in relieving symptoms of gastro-oesophageal reflux disease (GORD) than drug therapy. GORD is one of the most common diseases in gastroenterology and affects about 20-30% of Western adults.
GORD is a condition that is manifested by heartburn and the symptoms can be diverse and of different intensity (mild, moderate, etc.). Although there are several categories of drugs that can be given to patients with GORD, this is a chronic condition that can affect patient quality of life.
Drug treatment consists mainly in a class of drugs called proton pump inhibitors such as pantoprazole, omeprazole, lansoprazole and others. These drugs reduce gastric acid secretion and thus relieve the symptoms. But for these drugs to take effect, they must have taken in the morning before breakfast. There is also another class of medications called H2 receptor inhibitors, such as ranitidine, famotidine which take effect faster.
Gastroesophageal reflux disease is caused by the acid gastric reflux into the esophagus resulting in esophagitis. This reflux is favored by a number of factors such as certain foods (soft drinks, French fries, coffee, citrus, etc), obesity, certain medications that relax the lower esophageal sphincter, etc.. GORD is often associated with hiatal hernia. Patients with gastroesophageal reflux have heartburn, acid regurgitation, pain on swallowing (in severe cases) and other less common symptoms such as coughing.
Antireflux surgery may be an option when drugs do not take effect. However, opinions regarding which therapy is best for GORD have been controversial. In order to find out which is more effective (surgery or drugs), researchers conducted a study that compared the two treatment options. The study included 800 patients in the UK suffering from GORD for more than 12 months. Of these, 178 were treated surgically and 179 were randomly treated with medication. The rest chose to be treated with either surgery (261) or drug (192). Treatment follow-up period was 5 years.
Professor Craig Ramsay, of the University’s Health Services Research Unit, said that after one year of treatment, patients who had surgery had a greater improvement in symptoms than those who took medication. He added that other studies have shown that surgery patients had side effects such as difficulty in swallowing or inability to vomit, but now their study showed that these effects are present both in patients undergoing surgery and in patients taking medication. Fortunately, modern medicines relieve the symptoms for most patients, but surgery, when appropriate, can do even better”, said Professor Zygmunt Krukowski, a surgeon at Aberdeen Royal Infirmary.