Analysis Confirms Medication is as Effective as Surgery for Acid Reflux

December 21, 2005

Pharmaceutical Executive

Pharmaceutical Executive, Pharmaceutical Executive-12-21-2005, Volume 0, Issue 0

Agency hopes to inform healthcare providers and patients about comparisons of treatments for gastroesophagealreflux disease.

Medication for acid reflux disease is equally effective as surgery, according to the first in a series of reports on improving healthcare quality that were mandated by the 2003 Medicare Modernization Act.

    An extensive analysis of previously reported data conducted by the Agency for Healthcare Research and Quality (AHRQ) found that the older histamine type-2 blockers are not as effective as the newer protein pump inhibitors (PPIs) that appeared in the 1990s, explained Kenneth Fink, director of the agency's evidence-based practice centers program.

    According to Fink, there were some differences between traditional surgery, where part of  the stomach is wrapped around the sphincter separating the esophagus from the stomach, cutting off the flow of acid, and PPIs. But the clinical importance of these differences is unclear, he continued.

    The management of symptoms and increase in quality of life is similar between surgery and PPIs, he said, as are the long-term treatment benefits. Neither type of therapy was better at preventing cancer either.

    The information in the AHRQ report does not contain any new information, according to Jon Spechler, professor of gastroenterology at the University of Texas Southwestern Medical Center. The PPIs offer very good treatment, and surgery is not necessary for most people, he said.

    What's more, the effects of the surgery do not seem to last, after 10 years up to two-thirds of surgery patients are back on the medication, Spechler said.

    But some experts have speculated that PPIs might have long-term side effects that would not appear until patients have used them for many more years, Spechler added.

    For example, preventing acid from being pumped into the stomach up regulates the hormone that normally detects low levels of stomach acid, gastrin. As a result, people on PPIs have high levels of gastrin. Some people think this could cause growth problems, such as cancer, down the road.

    There was not enough evidence about new, non-invasive endoscopic surgery techniques to compare them to either drugs or traditional surgery, Fink said.

Spechler said the endoscopic techniques were too new and that he would not recommend them yet.