Long-term outcome of surgically and medically treated patients with gastroesophageal reflux disease: a matched-pair follow-up study.
OBJECTIVE
A recent randomized study has shown that the long-term effects of continuous medical treatment of gastroesophageal reflux disease (GERD) with a proton-pump inhibitor are comparable to those of open fundoplication. We compared the long-term effects of anti-reflux surgery with those of medical care according to clinical practice.


METHODS
This is a questionnaire-based 3-10 years follow-up study of 373 patients with GERD operated on in two hospitals with either open or laparoscopic fundoplication, and pair-matched non-operated controls treated medically according to clinical practice. The controls were matched for hospital, age, sex, follow-up time, degree of esophagitis, presence of hiatus hernia and Barrett's esophagus. The questionnaires used for symptoms and health-related quality of life (QoL) were the Gastrointestinal Symptoms Rating Scale and the Psychological General Well-Being Index, respectively.


RESULTS
Response rates were about 80%, and 179 pairs of operated patients and controls remained for analysis (102 based on laparoscopic and 77 on open fundoplication). Independently of the surgical technique, the operated patients suffered at the follow-up from significantly (p <0.001) fewer reflux symptoms than the non-operated controls, the mean scores being 1.34 and 2.51, respectively. The operated patients suffered from slightly more symptoms of indigestion (p <0.05). No consistent significant differences between the groups were found for QoL. Significant differences in QoL in favor of the operated patients were found when dealing only with the 43 pairs with no concurrent disease.


CONCLUSIONS
The study shows that in our area anti-reflux surgery is more effective in relieving reflux symptoms than medical care according to clinical practice.
Olberg
Petter
P
Section of Gastroenterology, Department of Medicine, St Olav's Hospital, Trondheim, Norway.
Johannessen
Rune
R
Johnsen
Gjermund
G
Myrvold
Helge E
HE
Bjerkeset
Tormod
T
Fjösne
Ulf
U
Petersen
Hermod
H
D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000523:psychology / Q000628:therapy*; D006635:Histamine H2 Antagonists / Q000627:therapeutic use*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D017060:Patient Satisfaction; D054328:Proton Pump Inhibitors; D011788:Quality of Life; D012189:Retrospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
D004791:Enzyme Inhibitors; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors