Surgery For Gastroesophageal Reflux Confirmed Beneficial
Despite the growing availability of prescription and over-the-counter medications for gastroesophageal reflux disease (GERD), surgical treatment remains a viable alternative for patients whose symptoms persist. In the May 2008 Archives of Surgery, surgeons from Massachusetts General Hospital (MGH) report their survey of almost 200 patients who had laparoscopic antireflux surgery at the MGH over a 10-year period. Specifically designed to assess GERD-related symptoms, the survey produced near-normal quality-of-life scores from most respondents, who also indicated considerable satisfaction with their long-term results.
"Our results indicate that, in appropriate selected patients, antireflux surgery is an excellent treatment alternative that provides very good results for patient quality of life," says David Rattner, MD, chief of General and Gastrointestinal Surgery at MGH and senior author of the report.
Many individuals experience gastroesophageal reflux - when acidic stomach contents rise into the lower esophagus, producing the burning sensation called heartburn. When those symptoms become chronic and occur more than twice a week, they are considered GERD. In addition to persistant discomfort, GERD can lead to serious consequences, including bleeding of the esophageal lining and, in the most serious cases, esophageal cancer. Lifestyle changes can reduce some GERD symptoms; and while many patients are helped by over-the-counter or prescription medications, symptoms persist for some individuals. Surgery designed to rebuild and strengthen the muscular valve between the esophagus and the stomach offers an option for these patients and for those who would like to avoid lifetime medication use.
Rattner explains that some recent reports in the medical literature have questioned whether the long-term benefits of surgical repair outweigh the risks present in any sort of surgery. Previous outcomes evaluations, which had inconsistent results, have used a survey designed to assess quality-of-life issues relevant to a number of disorders. This new study uses the Gestroesophageal Reflux Disease - Health-Related Quality-of-Life Scale (GERD-HRQL), which focuses on GERD symptoms. Copies of the GERD-HRQL survey were mailed to about 350 patients who had laparoscopic antireflux surgery at the MGH from 1997 to 2006.
Completed surveys were returned by 191 patients, who were responding an average of five years after surgery. Among patients whose procedure was their first antireflux operation, the average GERD-HRQL score was 5.71, similar to that of the normal population. Scores on the GERD-HRQL can range from 0 to 45, with 0 indicating no GERD-related symptoms. Patients whose procedure had been a reoperation had an average score of 14.25. Among first-procedure respondents, 71 percent indicated they were satisfied with their outcomes, and 88 percent responded that they would have the procedure again.
While 43 percent of respondents reported taking some antireflux medications after their surgery, most of those patients had not had any testing to verify the recurrence of GERD. "Some reports have claimed that resumption of antireflux medications indicates that surgery is a failure, but that isn't necessarily true," Rattner says. "The symptoms of GERD are so non-specific, and patients may resume taking medications on their own. When patients who resume these drugs have been actually tested for the presence of reflux, most of them are shown not to have GERD.
"Only 1.2 percent of survey respondents reported needing repeat surgery, which does not support others' assertions that about half these procedures fail," Rattner adds. "Our results let us say that, when this surgery is performed by an expert surgical team at a high-volume center, the outcome for most patients is excellent." Rattner is a professor of Surgery at Harvard Medical School. The study's co-authors are lead author Denise Gee, MD, MGH Department of Surgery, and Michael Andreoli, Boston University School of Medicine.