All of GastroHep is now free access! - Click here to register Read For FREE - Our full range of review articles - the global online resource for all aspects of gastroenterology, hepatology and endoscopy - 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


Review Articles
Slide Atlas
Video Clips
Online Books
Advanced Digestive Endoscopy
Classical Cases
Conference Diary
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


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

 02 August 2015

Advanced search
 31 July 2015 
Risk of hepatocellular carcinoma in chronic HCV with diabetes
 31 July 2015 
Prognostic index for hep C-related cirrhosis
 31 July 2015 
Reducing surgical site infection after stoma reversal
 30 July 2015 
Post-colonoscopy colorectal cancer rates
 30 July 2015 
Venous thromboembolism in colorectal surgery
 30 July 2015 
Saccharomyces boulardii for antibiotic-associated diarrhea
 29 July 2015 
Sitafloxacin-based triple therapy for H.pylori
 28 July 2015 
Lifestyle changes after colorectal cancer screening
 27 July 2015 
Fecal microbiota transplantation for severe C. difficile infection
 24 July 2015 
Causes of death in celiac disease
 23 July 2015 
Reduction in H. pylori prevalence
 22 July 2015 
Detection of esophageal eosinophilia and eosinophilic esophagitis
 21 July 2015 

Clinical outcomes for Barrett's esophagus neoplasia

 20 July 2015 
Certolizumab pegol for Crohn's disease
 17 July 2015 
Genetic variation and gastric cancer
 17 July 2015 
Colitis associated with anti-CTLA-4 therapy
 17 July 2015 

Sexual dysfunction after rectal cancer treatment

 16 July 2015 
Lynch syndrome screening by microsatellite instability
 16 July 2015 
Hormones and endometrial cancer in Lynch syndrome
 16 July 2015 
Relapse of IBD after discontinuation of anti-TNF therapy
 15 July 2015 
Risk prediction index for advanced colorectal cancer
 15 July 2015 
Aspergillus niger-derived enzymes
 15 July 2015 
Prophylactic omeprazole improves GI symptoms
 14 July 2015 
Combination therapies for chronic HCV
 14 July 2015 
Interferon- and ribavirin-free treatment regimen for HCV
 14 July 2015 
Cancer surveillance in ulcerative colitis
 13 July 2015 
Colon polyps in chronic inflammatory conditions of the colon
 13 July 2015 
Drugs and occult vs overt upper GI bleeds
 13 July 2015 
Anxiety and depression in functional GI disorders
 10 July 2015 
Daclatasvir in the treatment of chronic HCV
 10 July 2015 
Surveillance intervals to reduce colorectal cancer
 10 July 2015 
Stress and GI symptoms in IBD
 09 July 2015 
Opioid-induced esophageal dysfunction
 09 July 2015 
Marker of response to medical therapy in Crohn's
 09 July 2015 
Predictive factors for metastasis in colorectal cancer
 08 July 2015 

Nucleoside analogue therapy in HBeAg-negative chronic hepatitis B?

 08 July 2015 

Medical education in endoscopy training

 08 July 2015 
Chronic unexplained nausea and vomiting
 07 July 2015 
Anastomotic leak after elective surgery for colonic cancer
 07 July 2015 
Fecal transplantation for ulcerative colitis
 07 July 2015 
Obesity and risk of hepatocellular carcinoma
 06 July 2015 
Fecal microbiota transplantation
 06 July 2015 
Liver Failure–Sequential Organ Failure Scoring System
 06 July 2015 
Future colorectal surgery for metachronous cancers
 03 July 2015 
Tumors with mismatch-repair deficiency
 03 July 2015 
Aptitude of trainees in endoscopic ultrasonography
 03 July 2015 
Extracolonic pathologies in colorectal cancer
 02 July 2015 
Ulcerative colitis prognosis after thiopurines withdrawal
 02 July 2015 
Anastomotic leak and cancer cancer
 02 July 2015 
Health care use by IBD children
 01 July 2015 
Missed gastric cancers
 01 July 2015 
Oral mechanical bowel preparation
 01 July 2015 
Probiotics in IBD
 30 June 2015 
Split-dose preparations vs day-before bowel cleansing regimens
 30 June 2015 
Glucocorticoids and peptic ulcer bleeding
 30 June 2015 
NSAIDs and hearburn symptoms
 29 June 2015 
Prevention of pancreatitis after ERCP
 29 June 2015 
Advances in autoimmune pancreatitis
 29 June 2015 
Rescue therapy in ulcerative colitis
 26 June 2015 

Gene polymorphism in alcoholic liver disease

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