Surgery superior for treating PPI-resistant reflux-related heartburn

  • Spechler SJ & al.
  • N Engl J Med
  • 17 Oct 2019

  • International Clinical Digest
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • Surgery is superior to medical treatment for patients with confirmed proton-pump inhibitor (PPI)-resistant reflux-related heartburn.
  • Most patients referred to gastroenterologists for suspected PPI-refractory heartburn respond to treatment with omeprazole 20 mg twice daily with explicit instructions to take it 30 minutes before meals.

Study design

  • Researchers studied patients with suspected reflux-related heartburn (N=366; mean age, 48.5 years; men, 280), randomly assigning those with confirmed diagnoses (n=78) to surgical treatment (laparoscopic Nissen fundoplication), active medical treatment (omeprazole plus baclofen, some also with desipramine), or control medical treatment (omeprazole plus placebo).
  • They defined the treatment success as ≥50% decrease in Gastroesophageal Reflux Disease-Health-Related Quality of Life score at 1 year.
  • Funding: US Department of Veterans Affairs.

Key results

  • Treatment success with surgery was 67%, significantly superior to active medical treatment (28%; P=.007) or control medical treatment (12%; P<.001>
  • The difference in treatment success between the active medical group and the control medical group was 16 percentage points (95% CI, −5 to 38; P=.17).

Limitations

  • The study had a small sample size and no placebo comparator for surgical treatment.