Procedures Beat Meds To Help Patients Fight Obesity, GERD - New Technologies, Safer Options Provide Better Results For GI Disorders

Main Category: Acid Reflux / GERD
Also Included In: GastroIntestinal / Gastroenterology;  Obesity / Weight Loss / Fitness
Article Date: 22 May 2006 - 8:00 PDT

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Upper gastrointestinal surgical procedures to treat conditions like gastroesophageal reflux disease and obesity are becoming popular options, but the medical community still debates the effectiveness and safety of the procedures. Research presented today at Digestive Disease Week 2006 (DDW) demonstrates that common surgical procedures like gastric bypass and laparoscopic reflux surgery are safe and effective for most patient populations and offer superior control of the conditions and their symptoms. DDW is the largest international gathering of physicians and researchers in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery.

Bariatric Surgery at the Extremes of Age [Abstract M1549]

Approximately 17 percent of children and adolescents and 32 percent of adults in the United States are considered obese, with obesity among adolescents and older adults rising dramatically. While gastric surgeries are soaring in popularity, the safety and efficacy of the surgery for certain patient populations has been questioned. Researchers at the Mayo Clinic in Rochester, MN, evaluated the long-term risks associated with gastric surgery in both adolescents (12-18) and elderly patients (60 and older) and found them to be considerably lower than previously reported.

In this study, researchers selected 167 patients to undergo Roux-en-Y gastric surgery: 12 adolescents (12-18) and 155 older adults (60-76). In Roux-en-Y gastric surgery, the stomach is separated into two parts with the smaller pouch receiving food intake. The food pouch is then connected to the small intestine to create a new gastric outlet. Patients in both age groups were afflicted with serious obesity-related health conditions, including Type 1 and Type 2 diabetes, severe hypertension, sleep apnea, joint arthropathy and asthma.

The three-year follow-up of adolescents showed an average body mass index (BMI) decrease from 55 to 36, an 82 percent reduction in obesity-induced diseases and health conditions, and importantly, no deaths or serious complications. The five-year follow-up of older adults showed an average BMI reduction of 46 to 33 with a 51 percent reduction in obesity-induced diseases and health conditions. In this group, there was a one percent mortality rate, and 15 percent experienced complications.

"This study reveals that bariatric surgery is a safe and effective option for all ages, including severely obese adolescents and older adults," said Michael Sarr, M.D., of the Mayo Clinic and senior study author. "The remarkable decrease in BMI lowers the risk of health complications and increase chances for long-term survival for people battling with obesity. For adolescents especially, early treatment of obesity is instrumental in reducing the long-term health complications associated with obesity."

A Randomized Controlled Trial of Laparoscopic Nissen Fundolplication (LNF) versus Proton Pump Inhibitors for Treatment of Patients with Chronic Gastro-Esophageal Reflux Disease (GERD) [Abstract 256]

Gastroesophageal reflux disease (GERD), a chronic gastrointestinal disease that affects more than seven million people in the United States, is most commonly treated with medication or surgery to manage disease symptoms. Researchers at McMaster University in Ontario conducted a study to evaluate the efficacy of individual versus combined treatment regimens in attempt to further reduce symptoms. Results demonstrated that patients who managed symptoms with a class of medicines called proton pump inhibitors (PPI) and underwent laparoscopic Nissen fundoplication (LNF) experienced a significant reduction in symptoms associated with GERD. Proton pump inhibitors, such as omeprazole and lansoprazole, reduce symptoms and repair erosion to the esophagus by reducing the upswell of acid from the stomach into the esophagus. Doctors perform LNF with a video laparoscope, wrapping the upper part of the stomach around the lower esophagus to strengthen the control valve to decrease the upflow of stomach acid to the esophagus.

Researchers selected 98 chronic GERD patients who required long-term therapy. Researchers randomly divided the patient sample into two groups; one group initiated treatment with PPI and the other underwent LNF. Researchers evaluated patient symptoms every three months and conducted a 24 hour pH test on all patients at one year.

Study results showed that 24 hour pH levels and GERD symptoms improved in both the PPI and surgery groups. However, at one year follow-up, the overall symptom control score for patients on medication remained stable, while surgical patients experienced a significant improvement in their symptoms increasing from 73.3 to 90.2 on 100 point global rating scale. The global rating scale is an assessment of patient satisfaction with symptom control, on a scale of 0 (poor) to 100 (excellent).

"Although there is no known cure for GERD, this study reveals that patients maintaining long-term PPI therapy may experience a greater improvement in their symptoms with surgical intervention" said Mehran Anvari, M.D., of McMaster University in Ontario and lead study author. "This minimally invasive surgical procedure may allow some patients to manage GERD symptoms and forgo a long-term drug regimen."

Digestive Disease Week (DDW) is the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery. Jointly sponsored by the American Association for the Study of Liver Diseases (AASLD), the American Gastroenterological Association (AGA), the American Society for Gastrointestinal Endoscopy (ASGE) and the Society for Surgery of the Alimentary Tract (SSAT), DDW takes place May 20-25, 2006 in Los Angeles, California. The meeting showcases more than 5,000 abstracts and hundreds of lectures on the latest advances in GI research, medicine and technology.

Aimee Frank
newsroom@gastro.org
American Gastroenterological Association
http://www.gastro.org