Medications Found Effective for GERD
There is good news for the estimated 60 million Americans with gastroesophageal reflux disease (GERD): medications can be just as effective as surgery in managing disease symptoms.
GERD occurs when stomach acid backs up into the esophagus, triggering heartburn and sometimes causing esophageal damage.
"For many people who have health problems, there are often two or more options to make a choice about," says Dr. Carolyn M. Clancy, director of the Agency for Healthcare Research and Quality (AHRQ), which conducted the new study.
With GERD, says Dr. Clancy, the main question is "Should I take pills or should I have surgery?"
The new report should help many patients resolve that question.
Aimed at physicians and patients, the AHRQ report on GERD lists the various treatments available and the evidence for their safety and effectiveness.
The goal of these reports is to give the public and health workers the latest evidence-based treatment recommendations.
The report is the first Comparative Effectiveness Review from a new AHRQ program that compares alternative treatments for health conditions.
With the report, AHRQ also released plain-language summaries to help consumers and others review the findings quickly and understand them.
In creating the program, Congress emphasized the need for conveying the information at different levels of detail for different audiences, with special attention to making the findings useful for consumers.
"We are trying to make the information as transparent and as accessible as possible about what we know from the latest science," notes Dr. Clancy.
Among the findings: for chronic GERD, over-the-counter H2 receptor antagonist medications are not as effective as Proton Pump Inhibitors (PPIs), although PPIs have more side effects.
H2 receptor antagonists include Axid®, Pepcid®, Tagamet®, and Zantac®.
PPIs appear to have similar clinical effectiveness when compared to each another. PPIs include AcipHex®, Nexium®, Prevacid®, Prilosec OTC®, and Protonix.
And compared with surgery, PPIs appear to be similarly effective in relieving symptoms and improving quality of life.
"However, somewhere between 10 and 65 percent of people end up having to take medications after surgery," Dr. Clancy explains. "So, if you were going into surgery thinking 'Wow when I recover, I'm done, no more pills,' that might be misguided.
"What we are saying to the public is, 'Here's the information we've organized in a way that you can make an informed decision,'" says Dr. Clancy.
As data changes, the report will be updated, she adds.
Future reports will focus on breast cancer screening, medications for depression, and managing diabetes, Dr. Clancy says.
An expert on GERD, Dr. Gerald Berke, a professor of surgery at UCLA, says that the report is missing some important facts about the disease.
"In general, patients with GERD do respond to both surgical and medical treatment," says Dr. Berke. "However, the mainstay of therapy - which is not addressed - is alteration of diet and eating and sleeping habits."
Without alteration of lifestyle, most patients experience only limited improvement in signs and symptoms of GERD despite aggressive medical and/or surgical intervention, notes Dr. Berke.
"In addition, a small, but significant group of patients do not seem to respond to either medical, surgical management, or lifestyle modification, and the reason for their failure rate is currently unknown," adds Dr. Berke.
Dr. Mary Maish, an assistant professor of surgery and surgical director of the UCLA Center for Esophageal Disorders, says, "The recommendations fall in the realm of what is recommended in the medical literature. The report might be too technical for most patients."
Dr. Maish believes the report will be helpful for highly educated patients.
"For people who have an understanding of how scientific-based medicine actually works, it is great," she says. "For the average patient with reflux disease, it's probably a little too technical to follow and too long."
For physicians who do not treat GERD often, the report is a good summary, says Dr. Maish. "For people who treat GERD a lot, there isn't enough information," she says.
Always consult your physician for more information. |
