New plain-language reports compare the risks and benefits of therapies for gastroesophageal reflux disease (GERD), a digestive condition that affects millions of individuals in the U.S., and can be treated with medications or surgery. The reports are from the U.S. Department of Health and Human Services (HHS) Agency for Healthcare Research and Quality (AHRQ), and are based on an updated evidence publication also released today.
The study concluded that established treatment with medications is effective, and that laparoscopic fundoplication is at least as effective as drug-based treatments, however, it had an increased risk of serious adverse effects. Although there is another surgical treatment that uses an endoscopic variation of fundoplication, the AHRQ's study discovered that there is insufficient evidence to compare this procedure's effectiveness with other treatments.
In the U.S., GERD is one of the most common conditions, affecting around 4% of the population. The report noted that individuals who suffer from GERD can spend a considerable amount of money on treatments, estimated at $3,355 per year per patient. Roughly two-thirds of the costs are related to prescription drugs, but it appears that some medications to treat GERD, such as proton pump inhibitors (PPIs), are overused.
AHRQ Director Carolyn M. Clancy, M.D., explained:
"Because it affects so many Americans, GERD is an important disease both in terms of public health and coast. These new publications will help patients and their clinicians work together to find the best treatment option based on patient preferences and needs."
The report revealed that PPIs tend to be more effective than other medications, but comparisons show few consistent differences between PPI types of dosages. They can cause some adverse effects, such as diarrhea and headaches, but generally these are not serious.
GERD, often known as acid reflux disease, occurs when stomach contents regularly back up into the esophagus. When the stomach acid irritates the esophagus, it often causes heartburn. Some individuals who suffer from GERD develop a condition called Barrett's esophagus, when the lining of the esophagus is damaged by stomach acid, which can also increase the risk of developing esophageal cancer.
Severe and frequent symptoms are common among people with GERD - these patients require long-term regular use of antireflux drugs. For these patients, the aim of treatment is usually to improve symptoms and quality of life and the prevention of complications, such as Barretts esophagus. However, professionals are still not sure what the best way to achieve this is.
They also discovered that even though fundoplication, in which the upper section of the stomach is wrapped and sewn around the esophagus, decreased the use of antireflux drugs, it did not eliminate them. Furthermore, some individuals who underwent antireflux surgery showed improvement in reflux symptoms and quality of life. However, the investigators report severe adverse effects connected with surgery, including postoperative infections, difficulty swallowing, and postmeal bloating.
The new reports - a summary for consumers and a companion publication for clinicians - are based on the discoveries of a comprehensive report updated for AHRQs Effective Health Care Program by the Tufts Medical Center Evidence-based Practice Center. The report and the consumer and clinicians publications are available at www.effectivehealthcare.ahrq.gov.
Written by Grace Rattue