STUDY suggests heartburn surgery doesn't stop need for medication

Wednesday, May 9th 2001, 12:00 am
By: News On 6

CHICAGO (AP) _ Surgery for chronic severe heartburn may not eliminate the need for medication or prevent throat cancer, a study found.

The research also unexpectedly found that surgery patients were much more likely to die during the 10 years after their operations than patients treated with medication alone.

Many of the deaths were due to heart disease, stumping researchers who could not explain how surgery for heartburn _ which, despite its name, involves the esophagus _ might affect the heart.

The study was published in Wednesday's Journal of the American Medical Association.

The study is a follow-up to research on 247 patients published in 1992 suggesting that surgery is the best treatment for severe, chronic heartburn _ also called gastroesophageal reflux disease, or GERD. The earlier research, based on patients followed for two years, also suggested that surgery might alleviate the need for antacids or other medication.

The 10-year follow-up should temper enthusiasm for surgery to treat GERD, which affects an estimated 14 million Americans, said Dr. Stuart Jon Spechler, who led the study as chief of gastroenterology at the Veterans Affairs Medical Center in Dallas.

The study challenges the main arguments in favor of surgery: that it offers permanent relief, that it prevents cancer and that it frees people from having to take antireflux medicine.

``It has become a bit easier for physicians to offer patients with GERD reasons not to have antireflux surgery,'' Dr. Peter Kahrilas of Northwestern University wrote in an accompanying editorial.

Spechler said surgery might still be advised for patients who cannot tolerate medication, offering the possibility of at least a few years' relief.

GERD is caused by a faulty valve that allows stomach contents to back up and cause heartburn. Sufferers run an increased risk of esophageal cancer, presumably because of the constant irritation.

Medication is the most common treatment. But surgery also is done frequently and has become even more popular since 1991, when operations using tiny incisions _ or laparoscopies _ were introduced for reflux disease.

About 35,000 such operations are done annually, but they involve the same procedure as the more invasive surgery Spechler's patients underwent _ creating a new valve by wrapping part of the stomach around the end of the esophagus. The researchers suggest that laparacopies could have yielded the same results.

The new research involved 37 reflux patients operated on in the late 1980s and 90 treated with drugs alone. Medication included proton pump inhibitors, prescription drugs that stop the stomach from making acid.

Ten years after their operations, 62 percent, or 23, of the surgery patients reported that they were using antireflux medications regularly.

Four medicine patients and one surgery patient developed esophageal cancer, but the difference was not considered statistically significant.

Seventy-nine of the original 247 patients died: 40 percent of the original surgery patients but just 28 percent of the medicine group. Nearly half the surgery patient deaths were from heart disease.

Spechler said it is unknown whether surgery has some unknown harmful effects on the heart or whether reflux medications might somehow protect against heart disease.