Dr Lundell and colleagues compared long-term outcome after antireflux surgery with acid inhibition therapy in the treatment of chronic gastro-esophageal reflux disease (GERD).
The team allocated 154 patients with chronic GERD and esophagitis verified at endoscopy to treatment with omeprazole or 144 patients to antireflux surgery.
After 7 years of follow-up, 119 patients in the omeprazole arm and 99 who had antireflux surgery were available for evaluation.
The primary outcome variable was the cumulative proportion of patients in whom treatment failed.
|Post-fundoplication complaints remained a problem|
|British Journal of Surgery|
The researchers' secondary objectives were evaluation of the treatment failure rate after dose adjustment of omeprazole, and safety.
The research team also evaluated the frequency and severity of post-fundoplication complaints.
The proportion of patients in whom treatment did not fail during the 7 years was higher in the surgical than in the medical group.
The team found that a smaller difference remained after dose adjustment in the omeprazole group.
More patients in the surgical group complained of symptoms such as dysphagia, inability to belch or vomit, and rectal flatulence.
The researchers observed that these complaints were fairly stable throughout the study interval.
Chronic GERD can be treated effectively by either antireflux surgery or omeprazole therapy.
The research team showed that after 7 years, surgery was more effective in controlling overall disease symptoms.
However, specific post-fundoplication complaints remained a problem.
Dr Lundell's team concludes, “There appeared to be no dose escalation of omeprazole with time.”