Surgery or drugs for gastro-oesophageal reflux?

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 …