Antacids are as effective as surgery for treating severe heartburn, UT Southwestern physician shows

May 08, 2001

DALLAS - May 9, 2001 - Many Americans suffer heartburn, but for some it's more frequent and serious. A new study by a UT Southwestern Medical Center at Dallas physician, published in today's Journal of the American Medical Association, suggests that anti-reflux surgery is no better for treating severe heartburn than antacid medications.

Dr. Stuart Spechler, chief of gastroenterology at the Dallas Veterans Affairs Medical Center and vice chief of digestive and liver diseases at UT Southwestern, and his colleagues conducted a follow-up study of patients who had been treated 10 years earlier for gastroesophageal reflux disease, or GERD, to determine whether those who had surgery for the disease fared better than those who took prescription medication.

While the majority of patients were satisfied with whatever treatment they had received, the researchers were surprised to find two-thirds of the surgery patients still took anti-reflux medication regularly. The surgery patients had similar rates of developing esophageal strictures (narrowing of the esophagus from scarring) as patients who received medical therapy, and there was no significant difference between the groups in the development of esophageal cancer, both complications of severe GERD.

GERD is caused when a faulty valve at the lower end of the esophagus allows reflux, stomach acid flowing back into the food pipe, to occur. This acid can cause heartburn, irritate the voice and trigger chronic coughing. Approximately 20 percent of U.S. adults experience GERD symptoms at least once a week. Severe GERD burns ulcers in the lining of the esophagus and increases the risk of the usually fatal esophageal cancer. Treatment involves either surgery to repair the valve or prescription medication to reduce stomach-acid production.

Spechler and his team found 239 of the original 247 patients who took part in a 1986- 1988 VA study of medical and surgical anti-reflux treatments. By the time of the follow-up in October 1997, 79 patients had died. Among the survivors, 129 (91 in the medical-treatment group and 38 in the surgical-treatment group) took part in the follow-up.

For reasons still unclear, the surgical patients were more likely to have died from heart disease.

"Patients who are going to have an operation should consider very carefully their reasons for having the surgery. If they believe that surgery will allow them to never again take medicine for the treatment of reflux disease or that they are preventing a cancer of the esophagus, this study does not support either of these contentions," Spechler said.

A complication of GERD called Barrett esophagus is a strong risk factor for esophageal cancer, a malignancy that has dramatically increased over the past 20 years. Barrett esophagus is a complication in which intestinal-type lining cells are found in the esophagus. In this study, patients who had Barrett esophagus developed esophageal cancer at a rate of 0.4 percent per year, compared to 0.07 percent in those without Barrett esophagus.

"The findings of this study are interesting, and I would agree that patients must carefully weigh the risks and benefits of medical and surgical treatment before they choose a course of treatment," said Dr. Robert Rege, chairman of surgery at UT Southwestern.

"However, surgery remains an effective treatment for patients with GERD especially if they fail medical therapy. The data presented by Dr. Spechler may help us to decide which patients are best treated with medicine or surgery," Rege said.
-end-
Also participating in this research from UT Southwestern was Dr. Edward Lee, professor of pathology and chief of the pathology service at the Dallas VA. Other researchers from VA medical centers in Denver; West Roxbury, Mass.; Phoenix; Little Rock, Ark.; Tucson, Ariz.; Hines, Ill.; Richmond, Va.; Omaha, Neb.; and Perry Point, Md., also contributed to the study.

The study was supported by grants from the Department of Veterans Affairs Medical Research Service Cooperative Studies Program and Ethicon Endo-Surgery in Cincinnati.

UT Southwestern Medical Center

Related Cancer Articles from Brightsurf:

New blood cancer treatment works by selectively interfering with cancer cell signalling
University of Alberta scientists have identified the mechanism of action behind a new type of precision cancer drug for blood cancers that is set for human trials, according to research published in Nature Communications.

UCI researchers uncover cancer cell vulnerabilities; may lead to better cancer therapies
A new University of California, Irvine-led study reveals a protein responsible for genetic changes resulting in a variety of cancers, may also be the key to more effective, targeted cancer therapy.

Breast cancer treatment costs highest among young women with metastic cancer
In a fight for their lives, young women, age 18-44, spend double the amount of older women to survive metastatic breast cancer, according to a large statewide study by the University of North Carolina at Chapel Hill.

Cancer mortality continues steady decline, driven by progress against lung cancer
The cancer death rate declined by 29% from 1991 to 2017, including a 2.2% drop from 2016 to 2017, the largest single-year drop in cancer mortality ever reported.

Stress in cervical cancer patients associated with higher risk of cancer-specific mortality
Psychological stress was associated with a higher risk of cancer-specific mortality in women diagnosed with cervical cancer.

Cancer-sniffing dogs 97% accurate in identifying lung cancer, according to study in JAOA
The next step will be to further fractionate the samples based on chemical and physical properties, presenting them back to the dogs until the specific biomarkers for each cancer are identified.

Moffitt Cancer Center researchers identify one way T cell function may fail in cancer
Moffitt Cancer Center researchers have discovered a mechanism by which one type of immune cell, CD8+ T cells, can become dysfunctional, impeding its ability to seek and kill cancer cells.

More cancer survivors, fewer cancer specialists point to challenge in meeting care needs
An aging population, a growing number of cancer survivors, and a projected shortage of cancer care providers will result in a challenge in delivering the care for cancer survivors in the United States if systemic changes are not made.

New cancer vaccine platform a potential tool for efficacious targeted cancer therapy
Researchers at the University of Helsinki have discovered a solution in the form of a cancer vaccine platform for improving the efficacy of oncolytic viruses used in cancer treatment.

American Cancer Society outlines blueprint for cancer control in the 21st century
The American Cancer Society is outlining its vision for cancer control in the decades ahead in a series of articles that forms the basis of a national cancer control plan.

Read More: Cancer News and Cancer Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.