THURSDAY, Sept. 29 (HealthDay News) -- Medications are effective
for most patients with acid reflux disease, but some surgical
options may be just as effective, according to a review of studies
on current treatments for this common condition.
Acid reflux disease, also known as gastroesophageal reflux
disease or GERD, occurs when the contents of the stomach --
including burning acid -- chronically spill up into the esophagus,
causing heartburn and other symptoms such as a persistent cough,
laryngitis and asthma.
Acid reflux disease may afflict as many as 4 percent of
Americans, resulting not only in a sometimes significant financial
drain but also more serious long-term consequences such as
esophageal cancer, according to background information in the
report released Sept. 23 by the U.S. Agency for Healthcare Research
& Quality (AHRQ), part of the U.S. Department of Health &
Obesity, which is widespread globally and growing, probably ups
the risk for GERD.
The authors of the report looked at three categories of
treatment: medications; a type of surgery known as fundoplication,
often done laparoscopically; and fundoplication done using an
endoscope, or lighted tube, to guide surgeons.
Two classes of drugs are the mainstay of treatment for GERD:
proton pump inhibitors (PPIs) such as Nexium (esomeprazole),
Prevacid (lansoprazole) and Prilosec (omeprazole), and histamine-2
receptor antagonists (H2RAs), such as Tagamet (cimetidine) and
PPIs tended to be the more effective of the two drugs but there
wasn't much of a difference between different PPIs or dosages, said
Dr. Elisabeth Kato, a medical officer at AHRQ.
And generally side effects weren't all that serious, although
use of PPIs has been associated with an increased risk of some
bacterial infections and fractures.
Fundoplication is "surgery to wrap the upper portion of the
stomach around the esophagus," explained Kato. "The idea here is to
provide a bit of a barrier to stop the stomach acid from washing
back up into esophagus."
There were fewer studies on fundoplication than on drugs but the
studies that were done "suggested that for some patients, surgery
did help control some of their symptoms a little bit better but in
general didn't allow them to completely stop taking medications,"
There were also more severe side effects, including infections
and difficulty swallowing.
There was much less information on a third treatment, which is
essentially fundoplication done using an endoscope. There weren't
enough data to come to any conclusions about its effectiveness,
"I would say endoscopic therapies for GERD are really minimally utilized at this point in time ... and the data would suggest that, at best, it's fair-to-moderately effective," added Dr. Thomas Watson, chief of thoracic surgery at the University of Rochester Medical Center in New York.
Nor was it clear to the authors of the report which patients
would do better with which type of treatment, which treatment might
better prevent long-term complications such as cancer, or which
treatment was safer over the long haul.
"There are no clear-cut guidelines," Watson said. "It comes down to the severity of the disease, the age of the patient, their desires, their willingness or unwillingness to stay on long-term therapy, as well as their willingness or unwillingness to undergo surgery."
Added Dr. Benjamin Havemann, an assistant professor of internal
medicine at Texas A & M Health Science Center College of
Medicine: "This [study] does make the case for patients making an
educated decision in partnership with their treating
gastroenterologist and surgeon. What we're left with is two
compelling treatments for GERD [fundoplication and medication],
which have similar efficacy. In the end, in the absence of a gold
standard, it is important that management strategies for GERD be
tailored to the individual patient."
AHRQ also has consumer pamphlets on
treatments for GERD.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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