Surgery is beneficial for treatment of gastro-oesophageal reflux
News release from the National Coordinating Centre for Health Technology Assessment
08 November 2008
Research published by the National Institute for Health Research Health Technology Assessment (NIHR HTA) programme has found that early surgery is beneficial for patients with chronic symptoms of gastro-oesophageal reflux disease (GORD). Reflux is a very common condition with 20 per cent of the population experiencing it at some point in their lives.
Currently the management of people with GORD at the more severe end of the spectrum is primarily through the use of drugs in the form of tablets. Relatively few patients have surgical treatment, now performed using a 'key-hole' procedure known as a laparoscopic fundoplication. However, GORD may be a lifelong condition, and so could require 20-30 years of medical therapy if a patient is young when diagnosed.
A large team of researchers, led by Professor Adrian Grant from the University of Aberdeen, recruited 810 people from 21 hospitals across the UK to the £1.1 million trial, to compare the clinical effectiveness, cost-effectiveness, and safety of a policy of relatively early laparoscopic surgery compared with continued medical management.
The results showed that surgical treatment was more effective than long-term drug therapy, especially in patients with the most troublesome symptoms, certainly up to one year after the procedure. A surgical policy is, however, more costly than medical management and it is uncertain whether it would be cost-effective in the long-term.
"Extending the use of laparoscopic fundoplication to people whose GORD symptoms require long-term medication would provide better quality of life. Like all surgery, fundoplication has some risks, but the more troublesome the symptoms, the greater the potential benefit from the operation," says Professor Grant. "We believe that our research can help to better inform the management of patients with chronic symptoms of GORD."
The report published in Health Technol Assess 2008; Vol. 12:31. To view or download the full report visit www.hta.ac.uk/1134
Notes for editors
1. The HTA programme is a programme of the National Institute for Health Research (NIHR) and produces high quality research information about the effectiveness, costs, and broader impact of health technologies for those who use, manage and provide care in the NHS. It is the largest of the NIHR programmes and publishes the results of its research in the Health Technology Assessment journal, with more than 400 issues published to date. The journal's 2007 Impact Factor (3.87) ranked it in the top 10 per cent of medical and health-related journals. All issues are available for download free of charge from the website, www.hta.ac.uk The HTA programme is coordinated by the National Coordinating Centre for Health Technology Assessment (NCCHTA), based at the University of Southampton.
2. The National Institute for Health Research provides the framework through which the research staff and research infrastructure of the NHS in England is positioned, maintained and managed as a national research facility. The NIHR provides the NHS with the support and infrastructure it needs to conduct first-class research funded by the Government and its partners alongside high-quality patient care, education and training. Its aim is to support outstanding individuals (both leaders and collaborators), working in world class facilities (both NHS and university), conducting leading edge research focused on the needs of patients. www.nihr.ac.uk