Surgery for GERD
In recent years, people suffering from severe, chronic heartburn that cant be controlled with medications have turned to surgery with hopes for permanent relief and the prevention of esophageal cancer. But the results of a recent study that assessed the well being of patients a decade after they had surgery question its benefits.
Heartburn, also known as gastroesophageal reflux disease (GERD), occurs when the opening between the esophagus and stomach relaxes spontaneously, allowing acidic gastric juices to flow into the esophagus and cause irritation. Medications for GERD include antacids, proton pump inhibitors that decrease the amount of acid produced, and drugs that increase the tightness of the esophageal. Surgery, an option usually reserved for hard-to-treat GERD, involves folding the top of the stomach around the end of the esophagus to create a tighter opening. This procedure has become more popular with the development of minimally invasive techniques.
A study from the late 1980s of 247 heartburn patients found surgery was better than medication at controlling symptoms. However, ten years later a follow-up study of 239 of the original patients found many of the patients who underwent surgery still suffered from heartburn. Though their symptoms were less intense than those who received medication in the original study, 62% of the surgical patients still took antireflux medication regularly (compared to 92% of the medical patients).
The study also found that surgery failed to significantly decrease the risk for esophageal cancer compared to treatment with medication. Chronic heartburn is a risk factor for this cancer. However, the small size of the study combined with the low incidence of esophageal cancer did not rule out the possibility of a difference. A more surprising result of the study showed surgical patients were more likely to die than patients on medication. These deaths were not related to the surgery, but close to half (48%) were related to heart disease. The researchers were unprepared for this result and therefore have no data to explain this finding.
The results of this study suggest that while surgery may do a better job at controlling the symptoms of heartburn, it doesnt eliminate the need for medication or decrease cancer risk. In general, surgery should be seen as an option of last resort for those patients whose symptoms are hard to treat with medication.
June 2001 Update