Surgery more effective than medical management for gastrooesophageal reflux disease (GORD)

Clinical question: 
How effective is medical management compared with surgery (laparoscopic fundoplication) for adults with gastro-oesophageal reflux disease (GORD)?
Bottom line: 
There were statistically significant improvements in health-related quality of life (QOL) at three months and one year after surgery, compared with medical therapy. The size of the change reported, about 5 points on the SF36 scale, can be interpreted as “minimal detectable change”.¹ There were also significant improvements in GORD-specific QOL after surgery compared with medical therapy. There was evidence to suggest symptoms of heartburn, reflux and bloating were improved after surgery compared with medical therapy, but a small proportion of participants had persistent postoperative dysphagia. 1. Wyrwich, KW et al. Health Serv Res 2005;40:577–91.
Caveat: 
Overall rates of postoperative complications were low, but surgery was not without risk, and postoperative adverse events occurred, although they were uncommon. The costs of surgery are considerably higher (between 3 and 6 times) than the cost of medical management, although data were based on the first year of treatment; therefore, the cost and side effects associated with long-term treatment of chronic GORD need to be considered.
Context: 
GORD is a common condition, with up to 20% of patients from westernised countries experiencing heartburn, reflux, or both intermittently.
Review CD#: 
CD003243
PEARLS No: 
261
Date: 
May, 2010
Authored by: 
Brian R McAvoy