Surgery or Medication?
This is the million dollar question for many of us with severe gastroesophageal reflux disease but unfortunately there’s no right answer for everyone. However, there have been researchers looking at the options and the long term benefits and risks of both.
In Sweden, there has been a long term study1 going on for over 12 years now. The study started with over 300 people with reflux. Half of these people have been taking 20-40 mg of Prilosec daily and the other half had a Nissan Fundoplication surgical procedure. Seventy-one people in the Prilosec group and 53 people in the surgery group are still being followed.
The results show that after 12 years, 53% of the surgery group remain in remission whereas 45% of the Prilosec group remain in remission. Thirty eight percent of the surgery group needed additional care such as medication or additional surgery. Fifteen percent of the medication group needed a medication change or surgery.
There were side effects for both groups. Heartburn and reflux were more common with the medication group but the surgery group experienced more problems with swallowing, rectal gas and the inability to belch or vomit.
The researchers concluded that both surgery and medication are effective. Surgery was more effective for treating the reflux symptoms but had more significant side effects.
This same group is now following over 500 people comparing 20-40 mg of esomeprazole (e.g. Nexium) and laproscopic anti-reflux surgery (LARS). In this study2 they actually looked at esophageal tissue and found significant improvement after one year for both the surgery and the medication. This improvement continued at the 3 year mark. There was no significant difference though between the esophageal tissue in the surgery or medication groups. They did not look at the difference in side effects in this report.
So, what does this mean for you?
Both surgery and medication have side effects. There are new concerns about proton pump inhibitors and the use of medications such as Plavix*. Additionally, the newest research shows that patients on Proton Pump Inhibitors for prolonged periods (more than 5 years) are at a greater risk of breaking bones*. On the other hand, not treating puts you at a greater risk of ulcers, Barrett’s esophagus and esophageal cancer. All of these factors along with your own personal history need to be weighed and considered between you and your doctor in order to make the best decision for you. And, don’t forget second and third opinions never hurt if you feel you need them in order to make a good decision for yourself or a loved one.
*See my other shareposts for more information about the research about this.
- Lundell L, et.al.(2009). Comparison of outcomes twelve years after antireflux surgery or omeprazole maintenance therapy for reflux esophagitis. Clin Gastroenterol Hepatol. Dec;7(12):1292-8; quiz 1260. Epub 2009 May 31.
2. Fiocca R, et.al. (2009). Long-Term Outcome of Microscopic Esophagitis in Chronic GERD Patients Treated With Esomeprazole or Laparoscopic Antireflux Surgery in the LOTUS Trial. Am J Gastroenterol. 2009 Nov 10. [Epub ahead of print]