Long-term outcome of medical and surgical therapies for gastroesophageal reflux disease - Follow-up of a randomized controlled trial
Long-term outcome of medical and surgical therapies for gastroesophageal reflux disease - Follow-up of a randomized controlled trial
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DOI：
10.1001/jama.285.18.2331
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发表时间：
2001-05-09
影响因子：
120.7
通讯作者：
Williford, W
中科院分区：
文献类型：
--
作者：
Spechler, SJ;Lee, E;Williford, W
背景严重胃食管反流病（GERD）是一个终生问题，可并发消化性食管狭窄和食管腺癌，目的探讨胃食管反流病内科和外科治疗的长期疗效。1997年10月至1999年10月在复杂性GERD患者中进行的药物和手术抗反流治疗的前瞻性随机试验研究，平均（中位数）的持续时间为10.6年（7.3年）的内科患者和9.1年（6.3年）的手术patients.Participants二百三十九（97%）的原始247名研究患者被发现（79被证实死亡）。在160名幸存者中（157名男子和3名妇女;平均[SD]年龄，67 [12]岁），129主要观察指标抗反流药物的使用、胃食管反流病活动指数（GRACI）评分、食管炎分级、食管狭窄治疗频率、比较药物抗反流治疗组和胃底折叠术组的后续抗反流手术频率、36项健康调查简表（SF-36）评分、抗反流治疗满意度、生存率和食管腺癌发生率。结果90例内科病人中83例（92%）和37例外科病人中23例（62%）报告他们经常使用抗反流药物（P
Context Severe gastroesophageal reflux disease (GERD) is a lifelong problem that can be complicated by peptic esophageal stricture and adenocarcinoma of the esophagus,Objective To determine the long-term outcome of medical and surgical therapies for GERD.Design and Setting Follow-up study conducted from October 1997 through October 1999 of a prospective randomized trial of medical and surgical antireflux treatments in patients with complicated GERD, Mean (median) duration of follow-up was 10.6 years (7.3 years) for medical patients and 9.1 years(6.3 years) for surgical patients.Participants Two hundred thirty-nine (97%) of the original 247 study patients were found (79 were confirmed dead). Among the 160 survivors (157 men and 3 women; mean [SD] age, 67 [12] years), 129 (91 in the medical treatment group and 38 in the surgical treatment group) participated in the follow-up.Main Outcome Measures Use of antireflux medication, Gastroesophageal Reflux Disease Activity Index (GRACI) scores, grade of esophagitis, frequency of treatment of esophageal stricture, frequency of subsequent antireflux operations, 36-item Short Form health survey (SF-36) scores, satisfaction with antireflux therapy, survival, and incidence of esophageal adenocarcinoma, compared between the medical antireflux therapy group and the fundoplication surgery group. Information on cause of death was obtained from autopsy results, hospital records, and death certificates.Results Eighty-three (92%) of 90 medical patients and 23 (62%) of 37 surgical patients reported that they used antireflux medications regularly (P