Patients with severe gastroesophageal reflux disease (GERD) can choose between medication and surgery for relief of their symptoms, but researchers caution that while both strategies are effective, they're also different in some important ways.

In GERD, liquids in the stomach are regurgitated into the esophagus and the mouth. The sour-tasting fluid often feels like it's burning as it passes, and in fact, the substances it contains, such as acids and bile from the liver, can inflame and damage the esophagus.

In Sweden, Dr. Lars Lundell of Karolinska University Hospital in Huddinge and colleagues studied 255 patients with GERD: 122 who had surgery to control their reflux, and 133 who instead took a drug called omeprazole (Prilosec). The study was originally intended to last for 5 years, but now, after 12 years, Lundell and his team were still in regular touch with 53 patients from the surgery group and 71 from the omeprazole group.

And with 12 years of follow-up, the researchers conclude that both treatments leave room for therapeutic improvement.

In Clinical Gastroenterology and Hepatology, the investigators report that of the 53 patients who had surgery, 28 (53%) have remained in continuous remission. Of the 71 who took the medication, 45% who had dose adjustments and 40% who stayed on a fixed dose remained in continuous remission.

Overall, surgery was better at controlling GERD symptoms such as heartburn and regurgitation, but long-term omeprazole avoided postoperative difficulties in swallowing, flatulence and an inability to belch or vomit.

The researchers found it noteworthy that postoperative complaints did not decline over time. In addition, 38% of surgical patients eventually required medications to reduce stomach acids.

Quality-of-life scores were similar...in the two treatment groups throughout the entire study period, according to the article.

In an e-mail to Reuters Health, Lundell commented that most people would probably interpret the study as concluding that dose-adjusted omeprazole is almost as good as surgery.

In an editorial that accompanied the report by Lundell and colleagues, Dr. Stuart Jon Spechler of the University of Texas Southwestern Medical Center in Dallas said, I find it difficult to fathom why a typical GERD patient would opt for a potentially hazardous surgery to fix a problem managed almost as well by a reasonably safe medication.

The study was funded by AstraZeneca, which markets omeprazole as Prilosec.

SOURCE: Clinical Gastroenterology and Hepatology, December 2009.

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