Pills, Surgery Both Effective for Chronic Reflux:
TUESDAY, May 17 (HealthDay News) -- Both surgery and popular
medications such as Nexium, Prevacid or Prilosec can successfully
treat the discomfort of chronic reflux, according to new
Millions of Americans experience what's known formally as
chronic gastroesophageal reflux disease, or GERD. The condition is
caused by acidic stomach contents washing up into the esophagus.
GERD can have a debilitating effect on sleep, work and general
quality of life.
However, "we have made very dramatic improvement in our
treatment of GERD, that's the good news," said lead researcher Dr.
Jean-Paul Galmiche, a professor of gastroenterology in the College
of Medicine at Nantes University in France. Treatments include
laparoscopic surgical fixes and the use of proton pump inhibitor
(PPI) drugs such as Nexium (esomeprazole), Prilosec (omeprazole)
and Prevacid (lansoprazole).
The new study -- which was funded by Nexium's maker, AstraZeneca
-- found "dramatic improvement in the results of surgery and
excellent results also with medical therapy," he stated. There was
no real difference between the medical and surgical approaches in
terms of their overall ability to ease GERD, "which was not
expected," Galmiche said.
Each treatment option did have its merits and demerits, however.
For example, with surgery there is less regurgitation than with the
medications, Galmiche said, but on the other hand, "you have more
bloating and flatulence after surgery."
This means that the choice of one treatment over the other is
really up to the patient, he said. If you don't want to take pills
for the rest of your life you may opt for surgery, or if you fear
surgical complications you can opt for PPIs. "You can choose your
preferred treatment," Galmiche said.
The report was published in the May 18 issue of the
Journal of the American Medical Association.
The study included 554 people with GERD who had already
responded well to Nexium in a three-month try-out period prior to
their entry into the study. These participants were selected
because, according to one outside expert, people with reflux who do
not respond to a PPI probably have another condition other than
"Those are [also] the people who tend to not do as well on surgery, because a lot of them have non-acid reflux or another cause of their symptoms," explained Dr. Amar R. Deshpande, an assistant professor of gastroenterology at the University of Miami Miller School of Medicine.
Of the 554 people selected into the trial, 372 completed five
years of follow-up, including 192 randomly assigned to treatment
with Nexium and 180 assigned to laparoscopic antireflux
Although the study used Nexium as its PPI, Galmiche pointed out
that there is no reason why other drugs in this class wouldn't work
People taking Nexium were allowed to increase their dose as
needed, the investigators noted.
Five years after initiating treatment, the researchers found
that GERD was in remission for 85 percent of the patients who had
undergone surgery and 92 percent of the patients who were taking
Those taking Nexium had similar levels of heartburn and acid
regurgitation from the start to the end of the study. However,
these symptoms lessened among those who had surgery, the
For example, at five years, 13 percent of those taking Nexium
had acid regurgitation compared with 2 percent of those who
underwent surgery. Yet there was no significant difference between
the groups in the severity of heartburn, abdominal pain or
diarrhea, the investigators found.
In terms of complications, 11 percent of the surgery patients
had difficulty swallowing, compared with 5 percent of those taking
Nexium. Among those having surgery, more suffered bloating than
those taking Nexium (40 percent versus 28 percent) and the same
held for rates of (excess) flatulence (57 percent versus 40
percent), the researchers found.
In addition, about 29 percent of those who had surgery and 24
percent of those on Nexium experienced some serious adverse
Overall, however, "this large, multicenter randomized trial
demonstrated that with modern forms of antireflux therapy, either
by drug-induced acid suppression or after laparoscopic antireflux
surgery, most patients remain in remission for at least five
years," the study authors concluded.
Commenting on the study, Deshpande said that "if you did well on
Nexium and if you continued it or went to surgery, both afforded
you a nine out of 10 chance of staying in symptom remission over
the next five years."
As he sees it, GERD therapy typically becomes a personal choice.
"If you are taking one pill once a day, most people tend to want to
do that [rather] than undergo surgery," he said. However, it is
those who do well on a PPI that typically also do well after
surgery, he noted.
People who might opt for surgery are those who don't want to
take pills or are afraid of the side effects of PPIs, Deshpande
For more information on GERD, visit the
U.S. National Library of Medicine.
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