Long-term Outcome of Medical and Surgical Therapies for Gastroesophageal Reflux Disease

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Abstract
Gastroesophageal reflux disease (GERD) is one of the most common chronic disorders of the gastrointestinal tract.1,2 Surveys have shown that approximately 20% of US adults experience GERD symptoms such as heartburn and acid regurgitation at least once per week.3,4 GERD and its sequela, Barrett esophagus, are strong risk factors for esophageal adenocarcinoma,5,6 a malignancy that has nearly quadrupled in frequency during the past 2 decades.7 Medical treatment of GERD involves long-term administration of antacids and antisecretory agents,8 and patients in the United States may spend as much as an estimated $5 billion annually on antireflux medicines.9 Antireflux surgery (fundoplication) has become an increasingly popular form of therapy for GERD since minimally invasive (laparoscopic) surgical approaches have been developed.10,11 It has been estimated that 29 000 and 34 800 laparoscopic Nissen fundoplications were performed in the United States in 1998 and 1999, respectively (Synergy, a division of Quintiles Informatics, Waltham, Mass, unpublished data, March 2000).