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