LONG-TERM COMPARISON OF ANTIREFLUX SURGERY VERSUS CONSERVATIVE THERAPY FOR REFLUX ESOPHAGITIS

Objective The purpose of the study was to evaluate the long-term sympt omatic and endoscopic outcome in gastroesophageal reflux disease with erosive esophagitis, comparing conservative with operative management. Methods The study comprised 105 of 120 patients consecutively referre d for severe reflux symptoms to the gastroenterologic outpatient depar tment of a teaching hospital,where erosive esophagitis was confirmed e ndoscopically. If conservative management (modified lifestyle and medi cation) failed to relieve symptoms and heal the esophagitis, antireflu x surgery (Nissen fundoplication) was undertaken. Follow-up (median, 1 0.9 years) evaluation of all patients included comprehensive, standard ized interviews; self scoring of symptoms at the time of referral and currently; and observations at endoscopy. Results Nissen fundoplicatio n was performed on 37 of the 105 patients. At follow-up of these 37 pa tients, (31) 84% had no or only occasional mild heartburn, (33) 89% we re free from erosive esophagitis, and (2) 5% were taking H2 antagonist s or omeprazole. The corresponding figures in the 68 patients with onl y conservative treatment were (36) 53%, (31) 45%, and (14) 21%. The me an change in symptom score between referral time and follow-up was 5.7 in the surgically treated group and 1.7 in the nonsurgically treated group. Fifteen new cases of Barrett's metaplasia were found at follow- up. Conclusions In gastroesophageal reflux disease with erosive esopha gitis, surgical treatment gave results subjectively and objectively su perior to those from conservative management.