Git j club GERD surgery.

1. Kurdistan GEH Board J Club:
Supervised by:
Dr. Mohamed Alshekhani
Professor in Medicine
MBChB-CABM-FRCP-EBGH 2016
1

6. 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.

7. 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.