Is There a Best Treatment for GERD?

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With all the overeating at Thanksgiving and at Christmas, many have reached for the antacids to ease their heartburn and reflux symptoms. Often that is enough for the occasional symptoms of gastroesophageal reflux disease (GERD), but for patients with severe GERD it isn’t.

Dr. Lars Lundell of Karolinska University Hospital in Huddinge, Sweden and colleagues conducted a study that included 310 patients with esophagitis in an attempt to define the best treatment for GERD. Is medication or surgery better for relief of symptoms in severe GERD?

The 310 patients were were randomly assigned, 155 patients to each arm of the study-- 154 received omeprazole (1 withdrew before therapy began), and 144 received surgery (11 withdrew before surgery). Over 12 years, Lundell and his team were able to maintain regular contact with 53 patients from the surgery group and 71 from the omeprazole (Prilosec) group.

The researchers found that 53% of patients who underwent surgery remained in continuous remission, compared with 45% of patients given omeprazole with a dose adjustment and 40% with a fixed dose.

However, 38% of surgical patients required a change in therapeutic strategy compared with 15% of those on omeprazole. Therapeutic changes included addition surgery or adding medical therapy.

Heartburn and regurgitation were significantly more common in patients given omeprazole, whereas dysphagia, rectal flatulence, and the inability to belch or vomit were significantly more common in surgical patients. The therapies were otherwise well-tolerated.

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GERD is caused by frequent acid reflux. If chronic, this constant backwash of acid can irritate the lining of your esophagus, causing it to become inflamed (esophagitis). Over time, the inflammation can erode the esophagus, causing complications such as bleeding or breathing problems.

Common symptoms of GERD include:

  • A burning sensation in your chest (heartburn), sometimes spreading to the throat, along with a sour taste in your mouth
  • Chest pain
  • Difficulty swallowing (dysphagia)
  • Dry cough
  • Hoarseness or sore throat
  • Regurgitation of food or sour liquid (acid reflux)
  • Sensation of a lump in the throat

There are some conditions which can increase your risk of GERD. These include obesity, pregnancy, smoking, asthma, diabetes, and Zollinger-Ellison syndrome.

In addition to medication (antacids, H-2-receptor blockers, and proton pump inhibitors) and surgery, there are lifestyle changes that can help reduce your GERD symptoms. These include maintaining a healthy weight (or losing some weight), avoid tight-fitting clothing, quit smoking, elevating the head of your bed 6 inches, and avoiding eating 2-3 hours before lying down or going to bed.

In an editorial that accompanied the report by Lundell and colleagues, Dr. Stuart Jon Spechler of the University of Texas Southwestern Medical Center in Dallas said, "I find it difficult to fathom why a typical GERD patient would opt for a potentially hazardous surgery to fix a problem managed almost as well by a reasonably safe medication."

The study was funded by AstraZeneca, which markets omeprazole as Prilosec.

SOURCE:
Comparison of Outcomes Twelve Years After Antireflux Surgery or Omeprazole Maintenance Therapy for Reflux Esophagitis; Clinical Gastroenterology and Hepatology, Volume 7, Issue 12, Pages 1292-1298 (December 2009); Lars Lundell, Pekka Miettinen, Helge E. Myrvold, Jan G. Hatlebakk, Lene Wallin, Cecilia Engström, Risto Julkunen, Madeline Montgomery, Anders Malm, Tore Lind, Anders Walan, The Nordic Gerd Study Group

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