Randomized Trial of Medical versus Surgical Treatment for Refractory Heartburn

• Published in: The New England journal of medicine Vol. 381; no. 16; pp. 1513 - 1523
• Main Authors: Spechler, Stuart J, Hunter, John G, Jones, Karen M, Lee, Robert, Smith, Brian R, Mashimo, Hiroshi, Sanchez, Vivian M, Dunbar, Kerry B, Pham, Thai H, Murthy, Uma K, Kim, Taewan, Jackson, Christian S, Wallen, Jason M, von Rosenvinge, Erik C, Pearl, Jonathan P, Laine, Loren, Kim, Anthony W, Kaz, Andrew M, Tatum, Roger P, Gellad, Ziad F, Lagoo-Deenadayalan, Sandhya, Rubenstein, Joel H, Ghaferi, Amir A, Lo, Wai-Kit, Fernando, Ronald S, Chan, Bobby S, Paski, Shirley C, Provenzale, Dawn, Castell, Donald O, Lieberman, David, Souza, Rhonda F, Chey, William D, Warren, Stuart R, Davis-Karim, Anne, Melton, Shelby D, Genta, Robert M, Serpi, Tracey, Biswas, Kousick, Huang, Grant D
• Format: Journal Article
• Language: English
• Published: United States Massachusetts Medical Society 17.10.2019
• Subjects: Acids; Adult; Anxiety; Baclofen; Baclofen - therapeutic use; Biopsy; Desipramine; Desipramine - therapeutic use; Drug Resistance; Drug Therapy, Combination; Endoscopy; Esophagus; Female; Fundoplication; Gastroenterology; Gastroesophageal reflux; Gastroesophageal Reflux - complications; Gastroesophageal Reflux - drug therapy; Gastroesophageal Reflux - surgery; Heart; Heartburn - drug therapy; Heartburn - etiology; Heartburn - surgery; Humans; Hypersensitivity; Laparoscopy; Male; Medical treatment; Middle Aged; Muscle Relaxants, Central - therapeutic use; Mutation; Neuromodulation; Omeprazole; Omeprazole - therapeutic use; Patients; Proton pump inhibitors; Proton Pump Inhibitors - therapeutic use; Quality of Life; Questionnaires; Surgery; Surveys and Questionnaires; Veterans; United States > US
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMoa1811424

Patients who were referred to Veterans Affairs gastroenterology clinics with heartburn unresponsive to a proton-pump inhibitor had comprehensive evaluation for eligibility for a trial comparing Nissen fundoplication surgery with medical therapy. In the minority of patients who were confirmed to have PPI-refractory and reflux-related heartburn, surgery was more effective than medical treatment in controlling reflux symptoms.