Medications as Effective as Surgery for GERD, According to Study Mandated by Medicare Law

Proton pump inhibitors are as effective as surgery at treating gastroesophageal reflux disease, according to a report by the Agency for Healthcare Research and Quality, the Scripps Howard/Sacramento Bee reports. For the report, AHRQ researchers conducted an eight-month review of major medical studies and found that for most people with uncomplicated GERD -- which occurs when stomach acid enters the esophagus and causes heartburn and other symptoms -- PPIs such as Nexium and Prilosec can be as effective at relieving symptoms and improving the quality of life as surgery. The surgery wraps part of the stomach around the esophagus to control acid (Bowman, Scripps Howard/Sacramento Bee, 12/14). Other GERD drugs called H2 receptor antagonists, such as Pepcid and Zantac, are not as effective as surgery but are less likely to cause side effects, the study finds. In addition, the study finds that, although surgery sometimes is performed to end the need to take medications, between 10% and 65% of patients who receive the surgery must resume taking the drugs.

Study Series
The report is the first in a series of 10 studies mandated by the 2003 Medicare law that will compare the effectiveness and price of medical treatments. The remaining studies, to be released in coming weeks, will examine other issues related to treatment of Medicare beneficiaries, including depression, the off-label use of some anti-psychotic drugs, diabetes and different methods of breast imaging. The series of studies, called the "Effective Health Care Program," will focus on the Medicare population in fiscal years 2005 and 2006 but will consider issues affecting Medicaid and SCHIP beneficiaries in future years (Reichard,CQ HealthBeat, 12/14)

Clancy Comments
AHRQ Director Carolyn Clancy said, "As the first Comparative Effectiveness Review, this report opens a new and promising chapter for helping patients choose the best evidence-based treatment for their own situation. Today's report will help patients and health care providers make more informed choices when they consider how to manage the symptoms of chronic GERD, and especially when they consider surgery" (AHRQ release, 12/14). She said AHRQ is not making treatment recommendations based on the findings and noted that Medicare is prohibited from using the findings of the reviews alone as the basis for coverage decisions. She also said that United Healthcare, Consumer Reports, Aetna and America's Health Insurance Plans have expressed interest in distributing the findings to consumers (CQ HealthBeat, 12/14). Clancy said, "We're trying to give people the information they need to decide their approach; we're not telling them what to do, we're not being prescriptive" (Scripps Howard/Sacramento Bee, 12/14).

The report is available online. Note: You must have Adobe Acrobat Reader to view the report.