Surgery may provide long-term acid reflux relief

In many patients who suffer with severe heartburn - also known as gastroesophageal reflux disease or GERD - antireflux surgery can provide long-term improvement and resolution of symptoms, US researchers report.

In GERD, stomach acid seeps into the esophagus causing burning and pain in the chest.

In the short-term, antireflux surgery has been shown to provide excellent control of GERD symptoms in 85 percent to 95 percent of patients. However, findings from two recent long-term studies in unselected patients have suggested that good early results diminish with time.

Very few studies have looked at the long-term results of antireflux surgery, Dr. Brant K. Oelschlager and colleagues note in the American Journal of Gastroenterology.

Between September 1993 and September 1999, a total of 441 GERD patients had antireflux surgery for the first time at Oelschlager's center at the University of Washington in Seattle.

In 2004, the researchers were able to contact 288 (65 percent) of the patients for follow-up. The median follow-up period was 69 months, according to the report.

Heartburn, which was present in nearly all patients, improved with antireflux surgery in 90 percent of patients and resolved in 67 percent. Regurgitation, the next most common symptom, improved in 92 percent and resolved in 70 percent. Difficulty swallowing (also called dysphagia) also improved and resolved in the majority of patients.

Improvements in cough and hoarseness were noted in 69 percent of patients each. Most patients, however, did not experience resolution of these symptoms.

Long-term resolution of GERD symptoms was most likely in patients who were younger, male, and did not have difficulty swallowing at the outset.

Some side effects, however, were noted after surgery. Two percent of patients developed difficulty swallowing - a symptom they did not have before surgery - and 11 percent developed new or increased diarrhea. Nine percent experienced bloating.

Moreover, a substantial proportion of patients continued to take an antacid medication (41 percent) and a few patients required a second operation (3 percent).

Antireflux surgery "should be considered as an excellent option in the armamentarium for treating severe GERD," the investigators conclude.

In a commentary published with the study, Drs. Joel E. Richter and Daniel T. Dempsey, from Temple University in Philadelphia, agree with this conclusion, but emphasize that to achieve the best outcomes, antireflux surgery should be performed at "academic centers of excellence or community hospitals with experienced surgeons and gastroenterologists appropriately utilizing sophisticated esophageal labs."

They add that "reoperations are challenging and should be limited to high-volume centers of excellence."