Drugs as effective as surgery for chronic reflux

A new review of available data has good news for the estimated 60 million Americans with gastroesophageal reflux disease, concluding that drugs can be just as effective as surgery in managing disease symptoms.

Gastroesophageal reflux disease occurs when stomach acid backs up into the esophagus, triggering heartburn, and sometimes causing esophageal damage.

"For many people who have health problems, there are often two or more options to make a choice about," says Dr. Carolyn M.

Clancy, director of the U.S. Agency for Healthcare Research and Quality, which conducted the study. With gastroesophageal reflux disease, she says, the main question is, "Should I take pills or should I have surgery?"

The new report should help many patients resolve that question.

The report is the first in a series from the independent Agency for Healthcare Research Quality comparing treatments for common illnesses. Aimed at doctors and patients, the report on gastroesophageal reflux disease lists the various treatments available and the evidence for their safety and effectiveness. The goal of these reports is to give the public and health workers the latest evidence-based treatment recommendations.

"We are trying to make the information as transparent and as accessible as possible about what we know from the latest science," Clancy says.

Among the findings: For chronic gastroesophageal reflux disease, over-the-counter H2 receptor antagonist medications are not as effective as proton pump inhibitors, although PPIs have more side effects. H2 receptor antagonists include the brands Axid, Pepcid, Tagamet and Zantac.

PPIs appear to have similar clinical effectiveness when compared to each another. PPIs include the brands AcipHex, Nexium, Prevacid, Prilosec OTC and Protonix.

And compared with surgery, PPIs appear to be similarly effective in relieving symptoms and improving quality of life.

"However, somewhere between 10 and 65 percent of people end up having to take medications after surgery," Clancy says. "So if you were going into surgery thinking, 'Wow, when I recover, I'm done, no more pills,' that might be misguided.

"What we are saying to the public is, 'Here's the information we've organized in a way that you can make an informed decision,"' Clancy says. As data changes, the report will be updated, she adds.

Future reports will focus on breast cancer screening, drugs for depression and managing diabetes, Clancy says.

One expert thinks that the report may be too complex for most patients, and not detailed enough for most doctors.

"The recommendations fall in the realm of what is recommended in the medical literature," says Dr. Mary Maish, an assistant professor of surgery and surgical director of the UCLA Center for Esophageal Disorders. "The report might be too technical for most patients."

Maish believes the report will be helpful for highly educated patients. "For people who have an understanding of how scientific-based medicine actually works, it is great," she says.

"For the average patient with reflux disease, it's probably a little too technical to follow and too long."

For doctors who don't treat gastroesophageal reflux disease often, the report is a good summary, Maish says. "For people who treat gastroesophageal reflux disease a lot, there isn't enough information," she says. "It is too vague, because it doesn't include the studies that are cited."

Another expert thinks that the report is missing some important facts about the disease.

"In general, patients with gastroesophageal reflux disease do respond to both surgical and medical treatment," says Dr. Gerald Berke, a professor of surgery at UCLA. "However, the mainstay of therapy -- which is not addressed -- is alteration of diet and eating and sleeping habits."

Without alteration of lifestyle, most patients experience only limited improvement in signs and symptoms of gastroesophageal reflux disease despite aggressive medical and/or surgical intervention, Berke says. "In addition, a small but significant group of patients does not seem to respond to either medical, surgical management or lifestyle modification, and the reason for their failure rate is currently unknown," he adds.

(The HealthDay Web site is at http://www.HealthDay.com.)