Help
Subscribe


Submit Videos to GastroHep Read For FREE - Our full range of review articles
GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy
GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy Profile of Guido Tytgat Profile of Pete Peterson Profile of Peter Cotton Profile of Roy Pounder

Home

News  
Journals
Review Articles
Slide Atlas
Video Clips
Online Books
Advanced Digestive Endoscopy
Classical Cases
Conference Diary
PubMed
International GH Links
USA GH Links
National GH Links
National GI Societies
Other Useful Links




Emails on Gastroenterology and Hepatology
the National AIDS Treatment Advocacy Project
Visit the gastroenterology section of the EUMS

News

Minimal access surgery vs medical management for GERD

This week's issue of the British Medical Journal compares minimal access surgery with medical management for gastro-esophageal reflux disease.

News image

Dr Grant and colleagues from the United Kingdom determined the long term clinical effectiveness of laparoscopic fundoplication as an alternative to drug treatment for chronic gastro-esophageal reflux disease (GERD).

The research team performed a 5-year follow-up of multicenter, pragmatic randomized trial.

Setting Initial recruitment in 21 UK hospitals.

Responders to annual questionnaires among 810 original participants.

At entry, all had had GERD for more than 12 months.

The surgeon chose the type of fundoplication.

Medical therapy was reviewed and optimized by a specialist.

Subsequent management was at the discretion of the clinician responsible for care, usually in primary care.

44% of those randomized to surgery were taking antireflux medication
British Medical Journal

The researchers' primary outcome measure included self reported quality of life score on disease-specific REFLUX questionnaire.

The team's other measures were health status, use of antireflux medication, and complications.

By 5 years, 63% of patients randomised to surgery, and 13% of those randomized to medical management had received a fundoplication.
 
Among responders at 5 years, 44% of those randomized to surgery were taking antireflux medication versus 82% of those randomised to medical management.
 
The research team noted that differences in the REFLUX score significantly favoured the randomized surgery group.

The team observed that SF-36 and EQ-5D scores also favored surgery, but were not statistically significant at 5 years.

After fundoplication, 3% had surgical treatment for a complication, and 4% had subsequent reflux-related operations—most often revision of the wrap.

The research team found that long term rates of dysphagia, flatulence, and inability to vomit were similar in the 2 randomized groups.

Dr Grant's team concludes, "After 5 years, laparoscopic fundoplication continued to provide better relief of GORD symptoms than medical management."

"Adverse effects of surgery were uncommon and generally observed soon after surgery."

"A small proportion had re-operations."

"There was no evidence of long term adverse symptoms caused by surgery."

BMJ 2013; 346: f1908
30 April 2013

Go to top of page Email this page Email this page to a colleague

 28 April 2015

Advanced search
 28 April 2015 
Alcohol drinking and risk of liver cirrhosis
 28 April 2015 
Clinical outcomes after esophagectomy
 28 April 2015 
Risk factors of hepatocellular carcinoma
 24 April 2015 
GastroHep.com Easter break
 23 April 2015 
Gut microbiota modulation for alcoholic liver disease
 23 April 2015 
Moderate sodium restriction diet in cirrhosis
 23 April 2015 
Gastroesophageal junction disruption and obesity
 22 April 2015 
Hepatitis and mortality in hospitalized patients
 22 April 2015 
Magnetic sphincter augmentation for GERD
 22 April 2015 
Drug, herbal and dietary supplement hepatotoxicity
 21 April 2015 
Risk factors of postpartum bowel changes
 21 April 2015 
Tracking colonoscopy surveillance intervals
 21 April 2015 
PPI increases risk of cryptogenic liver abscess
 20 April 2015 
IBS after traveller's diarhea
 20 April 2015 
Economic impact of C. diff infection
 20 April 2015 
Adherence to Hep C treatments
 17 April 2015 
Synchronous colorectal advanced neoplasia
 17 April 2015 
PNPLA3 polymorphisms and NAFLD risk
 17 April 2015 
MELD score and colorectal resection
 16 April 2015 
Bleeding risk in colonic diverticulosis
 16 April 2015 
Minority use of high-volume hospitals for colorectal cancer
 16 April 2015 
Sleep and IBD
 15 April 2015 
Treatment of hepatocellular carcinoma
 15 April 2015 
Score predicts malignant bile duct obstruction
 15 April 2015 
Increased risk of Barrett esophagus
 14 April 2015 
Improving colorectal cancer screening uptake
 14 April 2015 
Colorectal cancer presenting under the age of 50
 14 April 2015 
Functional constipation vs constipation predominant IBS
 13 April 2015 
Fecal transplant for C. difficile
 13 April 2015 
Immune based treatments for HCC
 13 April 2015 
CRP and acute diverticulitis
 10 April 2015 
Hypnotherapy for IBS
 10 April 2015 
Adjuvant therapy after rectal cancer
 10 April 2015 
Viral outcomes in HCV infection
 09 April 2015 
Male IBD patients wishing to conceive
 09 April 2015 
Screening programs based on the fecal immunochemical test
 09 April 2015 
Management of esophageal food impaction
 08 April 2015 
Nonceliac gluten sensitivity
 08 April 2015 
Ambulatory hemorrhoidal surgery
 08 April 2015 
Iron fortification and gut inflammation
 07 April 2015 
Endoscopic managements of GI bleeds
 07 April 2015 
Interventions for eosinophilic esophagitis
 07 April 2015 
Treatment of Hep C virus
 06 April 2015 
Treatment for rectal cancer
 06 April 2015 
Risk stratifying Barrett's esophagus
 06 April 2015 
Cost-effectiveness of HCV
 03 April 2015 
Predicting advanced cancer in Barrett's
 03 April 2015 
Vitamin D deficiency and Hep B outcomes
 03 April 2015 
Hepatocellular carcinoma surveillance in cirrhosis
 02 April 2015 
Physical activity and NAFLD
 02 April 2015 
Genetic risk for Crohn's disease
 02 April 2015 
EUS for detection of pancreatic neuroendocrine tumors
 01 April 2015 
Analysis of liver fibrosis
 01 April 2015 
Obeticholic acid in primary biliary cirrhosis
 01 April 2015 
Mortality rates for upper GI bleeds
 31 March 2015 
HCV-HIV co-infection combination therapy
 31 March 2015 
Placement of nasoenteral feeding tubes
 31 March 2015 
Hepatic fat and gallbladder polyps
 30 March 2015 
Minimally invasive approach in colorectal procedures
 30 March 2015 
Prevalence of IBD in USA residents of Indian ancestry

Blackwell Publishing


GastroHep.com is a Blackwell Publishing registered trademark
© 2015 Wiley-Blackwell and GastroHep.com and contributors
Privacy Statement
Disclaimer
About Us