Surgery more effective than medical management for gastrooesophageal reflux disease

January 01, 0001

Surgery more effective than medical management for gastrooesophageal reflux disease

Clinical Question: How effective is medical management compared with surgery (laparoscopic fundoplication) for adults with gastro-oesophageal reflux disease (GORD)?

Bottom line: There were statistically significant improvements in health-related quality of life (QOL) at three months and one year after surgery, compared with medical therapy. The size of the change reported, about 5 points on the SF36 scale, can be interpreted as minimal detectable change.¹ There were also significant improvements in GORD-specific QOL after surgery compared with medical therapy. There was evidence to suggest symptoms of heartburn, reflux and bloating were improved after surgery compared with medical therapy, but a small proportion of participants had persistent postoperative dysphagia.

Caveat:Overall rates of postoperative complications were low, but surgery was not without risk, and postoperative adverse events occurred, although they were uncommon. The costs of surgery are considerably higher (between 3 and 6 times) than the cost of medical management, although data were based on the first year of treatment; therefore, the cost and side effects associated with long-term treatment of chronic GORD need to be considered.

Context:GORD is a common condition, with up to 20% of patients from westernised countries experiencing heartburn, reflux, or both intermittently.

Cochrane Systematic Review: Wileman SM et al. Medical versus surgical management for gastro-oesophageal reflux disease (GORD) in adults. Cochrane Reviews 2010, Issue 3. Article No. CD003243. DOI: 10.1002/14651858.CD003243.pub2. This review contains 4 studies involving 1232 participants.

Cochrane PEARLS Practical Evidence About Real Life Situations. No. 261, May 2010. .
Written by Brian R McAvoy. Published by the Cochrane Primary Care Group

Category: D. Digestive. Keywords: gastroesophageal reflux disease, GERD, surgery, medical management, laparoscopic fundoplication, quality of life
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 5 October 2010

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Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.