Monday 12 July 2010, 9:19AM
PEARLS 261, May 2010, written by Brian R McAvoy
Clinical question
How effective is medical management compared with surgery
(laparoscopic fundoplication) for adults with gastro-oesophageal
reflux disease (GORD)?
Bottom line
There were statistically significant improvements in
health-related quality of life (QOL) at three months and one year
after surgery, compared with medical therapy. The size of the
change reported, about 5 points on the SF36 scale, can be
interpreted as minimal detectable change.¹ There were also
significant improvements in GORD-specific QOL after surgery
compared with medical therapy. There was evidence to suggest
symptoms of heartburn, reflux and bloating were improved after
surgery compared with medical therapy, but a small proportion of
participants had persistent postoperative dysphagia.
Caveat
Overall rates of postoperative complications were low, but surgery
was not without risk, and postoperative adverse events occurred,
although they were uncommon. The costs of surgery are considerably
higher (between 3 and 6 times) than the cost of medical management,
although data were based on the first year of treatment; therefore,
the cost and side effects associated with long-term treatment of
chronic GORD need to be considered.
Context
GORD is a common condition, with up to 20% of patients from
westernised countries experiencing heartburn, reflux, or both
intermittently.
Cochrane Systematic Review
Wileman SM et al. Medical versus surgical management for
gastro-oesophageal reflux disease (GORD) in adults. Cochrane
Reviews 2010, Issue 3. Article No. CD003243. DOI:
10.1002/14651858.CD003243.pub2. This review contains 4 studies
involving 1232 participants.
Further references
1. Wyrwich, KW et al. Health Serv Res 2005;40:577 91.