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Medical vs Surgical Treatment of Gastroesophageal Reflux
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To the Editor: Dr Spechler and colleagues1 found that 62% of patients who underwent surgical therapy for gastroesophageal reflux disease (GERD) later required antisecretory therapy. However, their study design limits the conclusions on treatment efficacy because they did not follow their patients longitudinally over the entire follow-up period, but only assessed them at 1 point 10 to 13 years after the surgery or the initial medical treatment period. Patient outcomes during the decade preceding the time of the study are not known. This is a problem, particularly in assessing efficacy as measured by symptom and medication questionnaires, endoscopy, and pH monitoring.
Questionnaires regarding symptoms or medication use, even if they include questions about the distant past, are known to reflect only events in the recent past.2 The endoscopic and pH monitoring studies could not reveal the patients' status years before they were actually performed.
Because the surgical repairs are not . . . [Full Text of this Article]
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