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May 9, 2001

Surgical Therapy for Reflux Disease

Author Affiliations

Author Affiliation: Department of Medicine, Northwestern University Medical School, Chicago, Ill.

JAMA. 2001;285(18):2376-2378. doi:10.1001/jama.285.18.2376

With publication of a follow-up report on the Department of Veterans Affairs cooperative trial comparing long-term outcomes of medical and surgical therapy for gastroesophageal reflux disease (GERD) by Spechler et al in this issue of THE JOURNAL,1 it is clear that the decision to pursue antireflux surgery has not gotten any simpler. The status of the medical and surgical cohorts is reported 10 to 13 years after initial enrollment in the trial making this report the most complete, longest-term, and most carefully collected data available. By all standards, these patients had severe GERD, evident by the high proportion who had esophageal ulcers, strictures, or Barrett esophagus at baseline. Common wisdom argues that this is the group most likely to benefit from antireflux surgery: surgical correction is long-lasting, replaces antisecretory medications, and eliminates the subsequent cancer risk—or so the argument goes.