Dec. 18, 2005
 
HEALTH/MEDICINE
Drugs As Effective As Surgery in Managing Acid Reflux
 
By Lee Bowman
Scripps Howard News Service
 
The first of a new 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 Dec. 14, 2005 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 involve more serious disease of the esophagus, which can contribute to cancer there.
 
The report was based on an eight-month review of major medical studies done 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 less likely to cause side effects. Those drugs include Axid, Pepcid, Tagamet, and Zantac.
 
Although surgery is sometimes chosen with the goal of ending the need to take medications, the evidence is unclear 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. Over the next several months, nine more reports will be released. They will cover such areas as breast imaging to detect cancer, and an evaluation of the safety and effectiveness of pain medications taken for arthritis and joint disorders. But it's expected that as Medicare patients become increasingly involved with health plans that encourage the use of treatments that are both efficient and cost-effective, the reports will carry some weight in exam rooms and hospitals, as well as help patients decide what drugs they might need to have covered in a drug plan.
 
"I would expect that a Medicare patient who has been diagnosed with GERD would be able to use this report as they consider drug-plan options to see what medicines each plan offers and at what cost. The same thing would be true for a senior who has GERD symptoms off and on now, but may need to be on regular medications down the road," Clancy said during a session with health reporters in Washington.
 
The research agency is also taking note of what current studies don't tell about the relative merits of different drugs and other therapies, with an aim of getting private or public organizations to sponsor new studies. The AHRQ will set up and pay for some of those studies itself, although its budget is limited. "There's a lot out there about the effectiveness of specific drugs and therapies, but not a lot of head-to-head comparisons between them," Clancy noted.
 
She said it's also expected that once the drug benefit has been up and operating for a year or two, federal researchers will be able to track how many patients are taking which drug for a certain condition. Additionally, she said, researchers will be able to tell, to some extent, from patients' other Medicare charges, which drugs seem to be most useful.
 
Along with the technical report, AHRQ also released plain-language summaries to help consumers and others review the findings quickly and understand them, along with information about other ongoing studies and new subjects to be considered.
 
All the information is available on the Web at
 
http://www.effectivehealthcare.ahrq.gov.
 
Distributed by Scripps Howard News Service, http://www.shns.com