How do surgical and medical therapies compare for the treatment of gastroesophageal reflux disease (GERD)?

Updated: May 23, 2019
  • Author: Marco G Patti, MD; Chief Editor: BS Anand, MD  more...
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Answer

A British multicenter randomized study conducted by Grant et al also compared surgical treatment versus medical therapy in patients with documented evidence of GERD. [49] The type of laparoscopic fundoplication was decided by the respective surgeons. Individuals who had received medication for their condition had taken them for a median of 32 months before participating in the study. The investigators reported that by 12 months, 38% of those who had undergone surgery were taking reflux medication, compared with 90% of the individuals randomized to medical management. [49]

Long-term results of laparoscopic antireflux surgery have shown that, at 10 years, 90% of patients are symptom free and only a minority still take PPIs. [50]

Long-term follow-up results from a multicenter, randomized trial showed that, relative to pharmacotherapy, fundoplication maintained better symptomatic relief in the management of gastroesophageal reflux disease without evidence of long-term postsurgical adverse symptoms. At 5 years, among patients with a treatment response, almost twice as many of those randomized to medical management (82%) were taking antireflux agents relative to those who had been randomized to surgery (44%). [51]


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