Editorials

Surgery or drugs for gastro-oesophageal reflux?

BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f2263 (Published 18 April 2013) Cite this as: BMJ 2013;346:f2263
  1. Peter McCulloch, chair, IDEAL Collaboration
  1. 1Nuffield Department of Surgical Science, John Radcliffe Hospital, Oxford OX3 9DU, UK
  1. peter.mcculloch{at}nds.ox.ac.uk

Surgery is more effective, but patients need time to make up their minds preoperatively

No one could complain about a lack of randomised trials looking at the effectiveness of surgery for gastric reflux. Since the development of laparoscopic fundoplication, more than 130 papers, relating to more than 30 separate trials, have been published. But surprisingly, few of these trials have compared surgery with non-surgical treatment. Before the REFLUX trial, whose long term results are published in a linked paper by Grant and colleagues (doi:10.1136/bmj.f1908),1 only four studies had compared surgery with medical treatment. Most trials compared types of fundoplication or instrumentation (open, laparoscopic, or robotic). Comparisons of two ways of doing the same thing are easier, but comparisons of fundamentally different treatment approaches are usually more important.

Grant and colleagues report the five year outcomes of the multicentre REFLUX trial, which originally recruited 810 participants who had had gastro-oesophageal reflux disease for longer than 12 months at baseline. Self reported quality of life was better at five years on several measures in patients who underwent surgery than in those who received …

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