Surgery for Refractory GERD Works for Small Subset of Patients

By Kelly Young

Edited by Susan Sadoughi, MD

Antireflux surgery may be beneficial for refractory gastroesophageal reflux disease (GERD), but only for a highly selected group of patients, according to a New England Journal of Medicine study.

Roughly 370 Veterans Affairs patients with heartburn refractory to proton-pump inhibitors were enrolled, but 288 were excluded for various reasons (e.g., testing revealed non-GERD causes of heartburn). Ultimately, 78 patients were randomized to receive either laparoscopic fundoplication, medical treatment (omeprazole, baclofen, desipramine), or control medication (omeprazole plus placebo).

At 12 months, the proportion of patients who had treatment success (at least a 50% improvement in the GERD Health-Related Quality of Life score) was significantly higher in the surgery group (67% vs. 28% for active medication and 12% for control medication).

An editorialist cautions: "The findings should not translate into more patients with refractory heartburn being offered surgery without each case being judiciously evaluated on its merits, and only after extended trials of medical therapy."