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