Clinical Decisionmaking

Patients who undergo surgery for gastroesophageal reflux disease use less care later than those who receive only medications

An estimated 7 percent of Americans suffer from daily heartburn, and 15 to 44 percent suffer from heartburn monthly. This is often due to gastroesophageal reflux disease (GERD), a condition of abnormal acid exposure in the esophagus that leads to symptoms such as heartburn and regurgitation.

For many patients, reflux disease is a chronic disorder requiring lifelong therapy and increasing the risk of other serious esophageal disease. Patients who undergo surgery for GERD will use fewer GERD-related medications and outpatient visits than those who are treated only with medication, according to a study supported in part by the Agency for Healthcare Research and Quality (HS10384) through the Centers for Education and Research on Therapeutics (CERTs) program.

Wayne A. Ray, Ph.D., principal investigator at the Vanderbilt University CERT, and his colleagues studied matched groups of Tennessee Medicaid patients diagnosed with GERD receiving either surgery or medical therapy from 1996 through 2000. The 200 patients in the medically treated group were randomly matched to the 111 patients in the surgical group by demographic characteristics and previous use of acid-suppressing drugs. In 1996, all patients in the surgical group underwent fundoplication (surgery that creates a one-way valve in the esophagus to allow food to pass into the stomach but prevent stomach acid from flowing back up into the esophagus, thus preventing GERD). Patients in the medical group were treated without fundoplication.

During the 4-year followup period, the surgical group had fewer GERD-related outpatient physician visits (5.5 vs. 6.7 visits). During each year of followup, the proportion of patients using GERD medications was lower in the surgical group than in the medication only group (0.67 vs. 0.93 in year 1; 0.67 vs. 0.91 in year 2; 0.72 vs. 0.85 in year 3; and 0.74 vs. 0.90 in year 4, respectively).

See "Health care utilization after medical and surgical therapy for gastroesophageal reflux disease," by Leena Khaitan, M.D., M.P.H., Dr. Ray, Michael D. Holzman, M.D., M.P.H., and Walter E. Smalley, M.D., M.P.H., in the December 2003 Archives of Surgery 138, pp. 1356-1361.

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