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 18 February 2018

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News

PPIs match surgery in gastroesophageal reflux

Proton pump inhibitors are as effective as surgery in managing gastroesophageal reflux disease, shows the latest report from the US Agency for Healthcare Research and Quality.

News image

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The US Agency for Healthcare Research and Quality reports treatments for chronic uncomplicated gastroesophageal reflux disease.

The report reviews the effectiveness of medical treatments used by Medicare, Medicaid, and the State Children's Health Insurance Program.

The review was developed by the Tufts New England Medical Center in Boston, Massachusetts.

This review is the first to compares treatment by reviewing existing studies and comparing the outcomes.

The reviewers defined gastroesophageal reflux disease as heartburn or acid regurgitation at least once a week.

The report analyzed randomized and non-randomized comparative studies, recent meta-analyses and cohort studies.

PPIs relieved symptoms of reflux disease as effectively as fundoplication surgery
US Agency for Healthcare Research and Quality

The studies assessed the use of over the counter drugs, proton pump inhibitors (PPIs), fundoplication surgery, and endoscopic procedures.

The report showed that proton pump inhibitors were as effective as fundoplication surgery in relieving the symptoms of reflux disease.

Proton pump inhibitors were also as effective as fundoplication surgery in reducing exposure to esophageal acid, and improving patients' quality of life.

Only a few studies had directly compared these approaches, however, and the total number of patients studied was small.

The review found significant differences in clinical effectiveness between different proton pump inhibitors.

However, the differences noted were modest and the report found the clinical implications unclear.

The evidence showed that the drugs and surgery had similar long term effects in preventing the development of Barrett's esophagus or esophageal adenocarcinoma.

The review found that over the counter H2 receptor antagonist drugs were less effective than proton pump inhibitors.

Over the counter H2 receptor antagonists were, however, associated with fewer side effects, including headache, diarrhoea, and abdominal pain.

The report also noted that surgery was sometimes used to reduce the need for patients to take drugs.

The report showed that 10% to 65% of patients had to resume their use of drugs after having had surgery.

Carolyn Clancy, director of the agency, commented, “This report takes a new step by asking not merely which treatments can be effective, but how treatments compare with one another.”

“It will provide a useful balanced source for obtaining the best scientific information to help select the right treatment for the patient.”

“However, reviews do not constitute treatment recommendations and do not include cost considerations.”

“Randomized controlled trials with long term follow-up comparing laparoscopic fundoplication with proton pump inhibitors to assess the relative benefits and harms of each approach are needed.”

“More efficacy and safety data are also needed with new endoscopic approaches tested against sham procedures.”

AHRQ 2005: 13 December, Effective Health Care Report
12 January 2006

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