Git j club GERD surgery

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Kurdistan GEH Board J Club:Supervised by:

Dr. Mohamed AlshekhaniProfessor in Medicine

MBChB-CABM-FRCP-EBGH 2016

GERD:Med vs Surgery• Medical therapy is extremely “successful” in the treat ment of

symptoms&complicationsof GERD.• The methods to assess treatment outcomes forGERD have been

extremely variable among medical&surgicaltherapies.• Comparison between or even within classes of treatmentscan not

be accuratel yassessed without standardization of patient demo- graphics, scientific design& treatment assessment.

• Medical therapy offers a distinct advantage as it relates to risk vs the surgical therapeutic strategies for GERD.

• Clearly,medical therapy has been shown to be thesafest&mostcost-effective strategy compared with surgery,especially now withlow-cost PPI pricing with generic &over-the-counter options.

• Available datafrom RCTs demonstrate equal efficacy for up to 5-year follow-up for both approaches.

GERD:Med vs Surgery• True “medical failures” are rare, these patients should be

thoroughly evaluated before considering surgical antireflux option.• The response of patients to PPI &expertise of the surgeon,is

extremely important for best GERD surgical outcomes.• Antireflux surgery is a better treatment for durable control of the

patients whose primary troublesome symptom is volume regurgitation.

• Surgery for GERD should never be recommended to patients as a better way to prevent esophageal cancer related to GERD.

• Despite continued improvements in the ability to suppress acid via even more potent PPIs, remain opportunities for improvement.

• These would be in th earena of accelerating the onset of action so that PPIs could provide more rapid “on demand symptom relief.

• Medical&surgical therapies to better deal with ongoing symptoms for patients on PPIs with non– acidic reflux are needed.