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Comparative Effectiveness of Management Strategies for Adults With Gastroesophageal Reflux Disease: An Update

Slide: 21 of 26

Findings of the Comparative Effectiveness Review: Medication Versus Surgery

Many patients with GERD have frequent, severe symptoms that require long-term use of acid-reducing medications. Intermittent (on-demand), periodic, or continuous use of prescription or over-the-counter medications, especially H2RAs and PPIs, may be used. Surgery (fundoplication) is also a potential treatment option that may reduce the need for long-term medication use. Evidence of moderate strength indicates that fundoplication was at least as effective as continued medical treatment (and in some cases superior) in controlling GERD-related symptoms. Five of the seven evaluated studies for this comparison included only patients whose symptoms were already well controlled by medication. However, evidence of low strength indicates that serious adverse effects could be more common for surgery than for medical treatment. Evidence was insufficient to determine whether prevention of long-term complications (such as Barrett’s esophagus and esophageal adenocarcinoma) is equivalent between medical and surgical treatments.

Abbreviations:
GERD = gastroesophageal reflux disease
H2RA = histamine type 2 receptor antagonist
PPI = proton pump inhibitor