What's Up with Keeping Acid Down?

Acid reflux treatments compared in updated report

(RxWiki News) With so many treatment options for acid reflux disease, it can be hard for patients and doctors to know which course to take. A new report clears things up by comparing the benefits and risks of acid reflux treatments.

The report found that current drug-based treatments for acid reflux disease (the disease that causes heartburn) are effective. It also showed that laparascopic fundoplication (a surgery to strengthen the valve between the stomach and esophagus) works at least as well as drug-based treatment, but also has a greater risk for harmful side effects.

"Know your acid reflux treatment options."

The report was put together by Stanley Ip, M.D., and colleagues at the Department of Health and Human Services' Agency for Healthcare Research and Quality (AHRQ).

Acid reflux disease (also known as gastroesophageal reflux disease, or GERD) is one of the most common conditions in the United States. Treatment can cost an average of $3,355 per year. Most of these costs come from prescription drugs, even while "it is well recognized that some drugs used to treat GERD (such as proton pump inhibitors) are overprescribed," the author's write.

According to AHRQ Director Carolyn M. Clancy, M.D., acid reflux is an important disease both in terms of public health and cost. She says that reports like this one will help patients and their doctors work together to find the best treatment option based on the wants and needs of the patient.

The report found that a variety of drugs called proton-pump inhibitors (PPIs) are likely to work better than other drugs. Even though PPIs can cause some side effects like diarrhea and headaches, those side effects are usually not too serious.

"For some conditions a quick fix [like surgery] should not be in the mix," says says Steven Kussin, M.D., FACP, a gastroenterology expert and founder of central New York's only Shared Decision Center. "Some people hate taking pills. I tell my patients, 'You swallow up to 2000 times each day. Have a PPI accompany one or two of those swallows.'"

The researchers also assessed fundoplication - a surgery in which the upper part of the stomach is wrapped and sewn around the esophagus. The report found that this surgery helps patients lower the amount of drugs they need to take. However, the surgery did not eliminate the need to take drugs. Fundoplication was also associated with serious side effects, including infections, a hard time swallowing, and bloating after meals.

"The risks of surgery are often minimized while its benefits are emphasized," says Dr. Kussin, who did not participate in the study. "While anti-reflux surgeries are generally well tolerated, the risks of any invasive therapy can not be dismissed.

"If there is a successful pill-based therapy that is reasonably effective and well tolerated, there is no need to consider surgery," he adds.

Dr. Kussin continues, "When a condition like reflux offers a number of operative therapies only one thing is for sure: no single surgery is uniformly successful. Each has problems in its success, dangers and side effects. Up to 10% of patients will need a second surgery. More than half will need to continue medications. There may be an improvement in the quality of life but not in important clinical outcomes like esophageal cancer or scarring and subsequent difficulty with swallowing."

The report - which is part of a new series of publications for consumers and clinicians - is an update of a 2005 AHRQ review of acid reflux disease. The researchers looked through a database for studies that answered key questions such as "What is the evidence of the comparative effectiveness of medical, surgical, and other newer forms of treatments for improving objective and subjective outcomes in patients with chronic gastroesophageal reflux disease," and "Is there evidence that effectiveness of medical, surgical, and newer forms of treatments varies for specific patient subgroups?"

This report and other publications are available at http://www.effectivehealthcare.ahrq.gov/

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Review Date: 
September 27, 2011