New guides compare benefits and risks of GERD treatments
Research Activities, December 2011, No. 376
New plain-language publications from the Agency for Healthcare Research and Quality (AHRQ) compare the benefits and risks of treatments for gastroesophageal reflux disease (GERD), a digestive condition that affects millions of Americans and can be treated with medications or surgery. The publications are based on an updated evidence report recently released by AHRQ.
The report concluded that established drug-based therapy is effective. It also concluded that a type of surgical treatment known as laparoscopic fundoplication is at least as effective as drug-based medical treatment for some patients, but also had a higher risk of serious side effects. Another surgical treatment using an endoscopic variation of fundoplication also has been used to treat GERD, but AHRQ's analysis found there is not enough evidence to compare this type of surgery's effectiveness with other treatments.
GERD affects as many as 4 percent of Americans, making it one of the most common conditions in the United States. Those who have GERD can spend a significant amount of money on treatments—estimated at $3,355 annually per patient, the report noted. Approximately two-thirds of these costs are related to prescription drugs. However, it is commonly recognized that some drugs used to treat GERD, such as proton pump inhibitors (PPIs), are overused, according to the report.
"Because it affects so many Americans, GERD is an important disease both in terms of public health and cost," said AHRQ director Carolyn M. Clancy, M.D. "These new publications will help patients and their clinicians work together to find the best treatment option based on patient preferences and needs."
The AHRQ report found that PPIs tend to be more effective than other drugs, but comparisons show few consistent differences between PPI types or dosages. PPIs cause some side effects, such as diarrhea and headaches, but these were generally not serious. GERD, sometimes known as acid reflux disease, occurs when stomach contents frequently back up into the esophagus. GERD often causes heartburn, which occurs when stomach acid irritates the esophagus. Some patients with GERD develop a condition called Barrett's esophagus, a disorder in which the lining of the esophagus is damaged by stomach acid, which can increase the risk of esophageal cancer.
Many patients have frequent, severe symptoms requiring long-term regular use of antireflux medications. For these people with chronic GERD, the goals of therapy usually are improvement in symptoms and quality of life and the prevention of complications such as Barrett's esophagus. However, experts remain unsure how best to achieve this.
The report also found that fundoplication, in which the upper portion of the stomach is wrapped and sewn around the esophagus, decreased, but did not eliminate, the use of antireflux medications. In addition, some patients who underwent antireflux surgery demonstrated improvement in reflux symptoms and quality of life. However, the report found severe side effects associated with surgery, including postoperative infections, difficulty swallowing, and postmeal bloating.
The new publications—a summary for consumers and a companion publication for clinicians—are based on the findings of a comprehensive report updated for AHRQ's Effective Health Care Program by the Tufts Medical Center Evidence-based Practice Center.
The report, Comparative Effectiveness of Management Strategies for Adults with Gastroesophageal Reflux Disease, is an update of a 2005 AHRQ report. It is the latest comparative effectiveness review from AHRQ's Effective Health Care Program. More information about the program, The report, and the consumer and clinicians publications can be found at AHRQ's Effective Health Care Program Web site.