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From JAMA |

Modern Treatment for Gastroesophageal Reflux Disease:  Surgery vs Medication

W. Scott Melvin, MD
Arch Surg. 2011;146(9):1093-1094. doi:10.1001/archsurg.2011.202.
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This long-term follow-up article presents important data to help guide the treatment of the patient with gastroesophageal reflux disease (GERD). The incidence of GERD continues to increase in Western countries, correlating with the use and expense of antisecretory medications, Barrett esophagus, and esophageal adenocarcinoma. Despite the widespread use of proton pump inhibitors, many patients with GERD have poorly controlled symptoms or desire to have better symptom control and to be free of medications. This article reports the outcomes of a highly selected group of patients who respond well to medications and who are treated with antireflux surgery or medication with dose escalation as necessary. A rigorous follow-up period of 5 years helped to delineate the placebo effect of surgery and the long-term durability of medical therapy and operative intervention.

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