BMJ  2006;332:236 (28 January), doi:10.1136/bmj.332.7535.236-b

Letter

Gastro-oesophageal reflux disease

Surgery is an alternative

Editor—Gastro-oesophageal reflux disease, being increasingly common, is a huge problem, and prescribing of proton pump inhibitors is a large burden on the NHS. Fox and Forgacs mentioned surgical management towards the end of their article,¹ but we disagree with the implication that antireflux surgery is limited to those patients in whom medical management is either ineffective or poorly tolerated. For patients who do not want to remain dependent on daily drug treatment it may simply be an alternative treatment, a lifestyle choice.

Also not mentioned was our recent randomised controlled trial of laparoscopic Nissen fundoplication v proton pump inhibitors, carried out in the United Kingdom.² This gave results favouring surgical fundoplication. It was accompanied by our economic analysis,³ which shows that surgical management, in the long term, is the more cost effective solution. This is an important consideration in today's NHS.

North Hampshire Hospitals NHS Trust, Basingstoke RG24 9NA bmj{at}amigo.co.uk

Norfolk and Norwich University Hospital, Norwich NR4 7UY

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Competing interests: The authors' research was funded by Janssen Pharmaceuticals and Ethicon Endosurgery.

References

1. Fox M, Forgacs I. Gastro-oesophageal reflux disease. BMJ 2006;332: 88-93. (14 January.)[Free Full Text]
2. Mahon D, Rhodes M, Decadt B, Hindmarsh A, Lowndes R, Beckingham I, et al. Randomized clinical trial of laparoscopic Nissen fundoplication compared with proton-pump inhibitors for treatment of chronic gastro-oesophageal reflux. Br J Surg 2005;92: 695-9.[CrossRef][ISI][Medline]
3. Cookson R. Flood C. Koo B. Mahon D. Rhodes M. Short-term cost effectiveness and long-term cost analysis comparing laparoscopic Nissen fundoplication with proton-pump inhibitor maintenance for gastro-oesophageal reflux disease. Br J Surg 2005;92: 700-6.[Medline]

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Relevant Article

Gastro-oesophageal reflux disease

Mark Fox and Ian Forgacs
BMJ 2006 332: 88-93. [Extract] [Full Text] [PDF]