- The Washington Times - Wednesday, December 14, 2005

The first of a series of federal reports intended to guide Medicare patients and their doctors in treating complex diseases concludes that drugs are as effective as surgery in managing gastroesophageal reflux disease.

Commonly referred to as GERD or acid reflux, the condition is estimated to affect from 7 percent to 10 percent of all American adults and becomes more frequent with aging. It occurs when stomach acid enters the esophagus, causing heartburn and possibly long-term damage to the passageway linking the throat to the stomach.

The study, released yesterday by the Agency for Healthcare Research and Quality, compares treatments for chronic uncomplicated GERD. The condition is likely to require lifelong management, but does not lead to more serious diseases of the esophagus.

The report was based on an eight-month review of major medical studies conducted around the world. It found that, for most GERD patients, a class of drugs called proton pump inhibitors can be as effective in relieving symptoms and improving the quality of life as surgery that wraps part of the stomach around the esophagus to control acid. Examples of PPIs include AcipHex, Nexium, Prevacid, Prilosec OTC, and Protonix.

It said the evidence indicates that another class of reflux drugs, called H2 receptor antagonists, sold mainly over the counter, are not as effective in treating the condition, but also are less likely to cause side effects. Those drugs include Axid, Pepcid, Tagamet, and Zantac.

Although surgery sometimes is chosen with the goal of ending the need to take medications, the evidence is not clear as to whether the most common operation does eliminate the need to take drugs long-term. The studies reviewed indicated that anywhere from 10 percent to 65 percent of patients had to go back to taking drugs during follow-up periods that usually didn’t extend beyond a year or two.

The federal reports — mandated by Congress as part of the Medicare reforms that established the new drug-benefit program, set to begin in January — are intended to sift through scattered evidence for alternative treatments for common illnesses among the elderly and lay out options in relatively plain language.

“We’re trying to give people the information they need to decide their approach; we’re not telling them what to do, we’re not being prescriptive,” said Dr. Carolyn Clancy, director of the research agency.

In fact, Congress specifically bars Medicare from deciding what will or won’t be covered from the information in the reports.

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