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Ip S, Bonis P, Tatsioni A, et al. Comparative Effectiveness of Management Strategies For Gastroesophageal Reflux Disease [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2005 Dec. (Comparative Effectiveness Reviews, No. 1.)
This publication is provided for historical reference only and the information may be out of date.
Comparative Effectiveness of Management Strategies For Gastroesophageal Reflux Disease [Internet].
Show details- More studies are needed to clarify how patients with GERD should be managed based upon patient characteristics or response to previous therapy. Additional information is needed to select patients for specific testing for GERD and to determine how treatment should be guided by the results of testing.
- Methods need to be developed to identify patients who do not need long-term antisecretory medications to minimize their exposure to life-long medications.
- Empiric acid-suppression therapy in patients with GERD symptoms to confirm the diagnosis of GERD is imperfect. Data are needed to determine the cost-effectiveness of such an approach.
- Long-term studies are needed to assess the risks associated with acid suppression on the development of pneumonia and enteric infections and to assess the consequences of long-term hypergastrinemia.
- Randomized controlled trials of laparoscopic fundoplication versus PPIs with long-term follow-up are needed to ascertain the relative benefits and harms of each approach and whether certain subgroups are better served with one of the other alternative.
- Unmeasured differences in the surgical procedures (for example, the size of the bougie and length of the wrap) may have accounted for some differences among surgical series. Additional research might clarify which technical aspects of the surgical procedures are important for optimizing surgical outcomes.
- Studies to assess the efficacy and safety of antireflux surgery performed in a community setting compared with an academic setting are needed.
- Studies to address the annual number of operations per surgeon or center to maintain skills are also needed.
- Data on comparative endoscopic treatments with continued (or intensified) use of PPIs are needed to better understand their efficacy against an established standard.
- More efficacy and safety data on new endoscopic approaches tested against a sham procedure with adequate follow-up are needed.
- Future studies should use rigorous and validated standards for comparing all relevant clinical outcomes. Similarly, future studies should define as clearly as possible the certainty of the diagnosis of GERD and use measures that help define its severity.
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