Surgery and Nexium equally good for curbing GERD

Both laparoscopic anti-reflux surgery and proton pump inhibitors such as Nexium provide long-term control of gastroesophageal reflux disease, commonly known as GERD, French researchers reported Tuesday. With either approach, at least 85% of patients achieved long-term relief of symptoms, the team reported in the Journal of the American Medical Assn.

GERD is caused by the reflux or bubbling up of stomach acids into the esophagus, producing intense pain. Inflammation of the esophagus caused by the acid can eventually lead to cancer in some cases. It is commonly treated with proton pump inhibitors, which block the production of acid in the stomach, limiting the amount that can reach the esophagus. Such drugs include omeprazole (Prilosec, Zegerid, Losec), esomeprazole (Nexium), lansoprazole (Prevacid) and pantoprazole (Protonix). Alternatively, surgeons can perform surgery to reinforce the valve that normally prevents acid from backing up into the esophagus. This is generally accomplished by wrapping a small section of the stomach around the valve to strengthen it. This is most often done in a minimally invasive procedure called laparoscopic anti-reflux surgery, or LARS.

Dr. Jean-Paul Galmiche of Nantes University in Nantes, France, and his colleagues studied 554 patients at academic hospitals in 11 European countries. All the patients were found to respond to proton pump inhibitors. Half were then randomly assigned to undergo surgery and half to receive regular doses of esomeprazole. All were followed for five years.

A total of 372 patients completed the five-year follow-up, 192 who received the drug and 180 assigned to undergo LARS. After five years, the researchers reported, about 85% of patients in the LARS group had no flareups of GERD requiring further intervention, compared with 92% in the drug group. Acid regurgitation was worse in the drug group, but there was no significant difference in the rates of heartburn. Surgery patients had more difficulties swallowing and more bloating and flatulence. Both groups had similar levels of abdominal pain, diarrhea and “serious adverse events,” such as bone fractures and cardiovascular disease.

The study was funded by Astrazeneca, which manufactures Nexium.