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Therapeutics
Surgery relieved symptoms but decreased survival more than medical treatment in gastro-oesophageal reflux disease

https://doi.org/10.1136/ebm.7.1.26

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    Spechler SJ, Lee E, Ahnen D, et al. Long-term outcome of medical and surgical therapies for gastroesophageal reflux disease. Follow-up of a randomized controlled trial.JAMA2001 May 9;285:2331–8.
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 QUESTION: In patients with complicated gastro-oesophageal reflux disease (GORD), how do the long term outcomes of surgical treatment compare with those of medical treatments?

    Design

    Randomised (allocation concealed*), blinded (unclear),* controlled trial with a mean follow up of 10 years.

    Setting

    8 Veterans Affairs medical centres in the US.

    Patients

    247 patients (mean age 58 y) with complicated GORD. 129 of 160 surviving patients (mean age 67 y, 98% men) were included in the follow up analysis.

    Intervention

    Patients were allocated to receive surgical treatment (n=82), continuous medical treatment (n=77), or symptomatic medical treatment (n=88). The method of surgical treatment was open Nissen fundoplication. Continuous medical treatment consisted of 2 antacid tablets, 1 and 3 hours after meals; ranitidine 150 mg twice daily; and metoclopramide 10 mg 4 times daily, and sucralfate 1 g …

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    Footnotes

    • Sources of funding: Department of Veterans Affairs Medical Research Service Cooperative Studies Program and Ethicon Endo-Surgery.

    • For correspondence: Dr S J Spechler, Division of Gastroenterology (111B1), Department of Veterans Affairs Medical Center, 4500 South Lancaster Road, Dallas, TX 75216, USA.sjspechler{at}aol.com.

    • ↵* See glossary.