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    Surgery effective option for some GERD patients refractory to PPI's: NEJM

    Written by Dr. Kamal Kant Kohli Kohli Published On 2019-10-17T20:10:17+05:30  |  Updated On 17 Oct 2019 8:10 PM IST
    Surgery effective option for some GERD patients refractory to PPIs: NEJM

    Heartburn that persists despite proton-pump inhibitor (PPI) treatment is a frequent and taxing clinical problem. The present available treatment options including Baclofen and desipramine have unproven efficacy. According to results from a randomized trial, surgery may be more effective than medical therapy in reflux-related heartburn refractory to proton pump inhibitors (PPIs). The findings of the new study have appeared in the New England Journal of Medicine.


    Dr Stuart J. Spechler, MD, from Baylor University Medical Center, Dallas, and coauthors in this study, randomized patients either to laparoscopic Nissen fundoplication, treatment with omeprazole plus baclofen with desipramine depending on symptoms, or a control treatment of omeprazole plus placebo. The primary outcome was treatment success, defined as a decrease of 50% or more in the Gastroesophageal Reflux Disease (GERD)–Health-Related Quality of Life score (range, 0 to 50, with higher scores indicating worse symptoms) at 1 year.


    The authors noted that 366 patients with PPI-refractory heartburn were originally enrolled in the study, then treated with 20 mg of omeprazole twice daily for 2 weeks with strict instructions to take 20 minutes before breakfast and dinner. Of these patients, 42 had their symptoms relieved by the omeprazole treatment and so were excluded from the randomization.







    The researchers encountered a significantly higher rate of treatment success at 1 year – defined as 50% or greater improvement in gastroesophageal reflux disease health-related quality of life score – in the surgery group (67%), compared with the medical-treatment group (28%) and control-medical group (12%). This implied an unadjusted 138% greater chance of treatment success with surgery, compared with active medical treatment, and a greater than 400% increase for surgery, compared with the control medical treatment.





    In addition, a prespecified subgroup analysis among people with reflex hypersensitivity or abnormal acid reflux also revealed the incidence of success with surgery as 71% and 62%, respectively. The investigators described this finding as highly significant given that reflux hypersensitivity was considered a functional disorder that would not be expected to improve with a procedure that didn’t alter abnormal oesophagal pain perception.


    The researchers concluded that among patients referred to VA gastroenterology clinics for PPI-refractory heartburn, systematic workup revealed truly PPI-refractory and reflux-related heartburn in a minority of patients. For that highly selected subgroup, surgery was superior to medical treatment.


    “This trial highlights the critical importance of systematic evaluation, similar to that recommended by Gyawali and Fass for managing the care of patients with PPI-refractory heartburn,” they wrote. “Many patients would not complete this rigorous evaluation, and among those who did, the cause of heartburn in most of them was not [gastroesophageal reflux disease].”

    For further reference log on to :

    Spechler SJ et al. N Engl J Med. 2019 Oct 16. doi: 10.1056/NEJMoa1811424.
    Gastroesophageal Reflux DiseaseGERDHeartburnindian medical newsMedical newsPPIPPI drugsPPI medicationPPI side effectsPPI tabletsProton pump inhibitorproton pump inhibitor drugsProton pump inhibitorssurgery
    Source : New England Journal of Medicine

    Disclaimer: This site is primarily intended for healthcare professionals. Any content/information on this website does not replace the advice of medical and/or health professionals and should not be construed as medical/diagnostic advice/endorsement or prescription. Use of this site is subject to our terms of use, privacy policy, advertisement policy. © 2020 Minerva Medical Treatment Pvt Ltd

    Dr. Kamal Kant Kohli Kohli
    Dr. Kamal Kant Kohli Kohli
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