Page last updated at 00:06 GMT, Saturday, 8 November 2008

Surgery beneficial in heartburn

By Emma Wilkinson
BBC News health reporter

PPIs
Proton pump inhibitors are the standard treatment for reflux

People with persistent heartburn should be considered for early surgery to prevent a lifetime of popping pills, NHS research suggests.

A year after keyhole surgery, only 14% of patients were still taking medication, compared with 90% of those treated with drugs alone.

The 1m trial of 800 patients suggests surgery should be done more routinely in patients with chronic acid reflux.

Experts said there was a view among GPs that surgery was "too extreme".

Researchers at the University of Aberdeen co-ordinated the trial of laparoscopic fundoplication at 21 hospitals around the UK.

For some people, it is a serious problem which could potentially mean a lifetime of tablet taking
Professor Roger Jones, King's College London

The results so far suggest the procedure, although expensive at 2000 per patient, is cost-effective because reflux sufferers no longer have to take medication and their quality of life improves.

But they are following the patients for five years to check the benefits are long-term.

The operation involves wrapping a piece of the stomach around the oesophagus to create a new valve to prevent acid backing up from the stomach.

It used to be done by opening up the chest cavity, but with the advent of keyhole surgery is now a lot safer.

Common problem

Reflux is a very common condition with 20% of the population experiencing it at some point in their lives.

Those at the more severe end of the spectrum end up taking tablets for the rest of their lives - potentially for 20 to 30 years in younger patients - and few currently receive surgery.

Study leader, Professor Adrian Grant, said: "It looks pretty promising.

"I think these results will mean that surgeons will be suggesting the operation in those patients who are not quite so bad."

He added: "Like all surgery, fundoplication has some risks, but the more troublesome the symptoms, the greater the potential benefit from the operation."

Professor Roger Jones, head of general practice at King's College London and chair of the Primary Care Gastroenterology Society said surgery was often regarded as "too extreme" for something which is not a serious problem.

"But for some people, it is a serious problem which could potentially mean a lifetime of tablet taking."

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