Esophageal.doc

Esophageal, Gastric, and Duodenal Disorders: A Clinical Update J. Patrick Waring, MD ?? Introduction Dr. Walter Peterson and Dr. Peter Kahrilas chaired the plenary session for the Esophageal, Gastric and Duodenal section of the American Gastroenterological Association. The papers presented represent the 6 finest abstracts, chosen from over 1200 submissions to this section. Medical and Surgical Therapies for Gastroesophageal Reflux Disease Stuart Spechler, MD, presented follow-up data from the VA Cooperative Study Group for gastroesophageal reflux disease (GERD).[1] This prospective, randomized trial was conducted from July 1986 to November 1989 and compared the long-term outcomes of medical and surgical therapies for GERD; the original results have been previously published (N Engl J Med. 1992;326:786). The study authors included researchers from Dallas, Texas; Denver, Colorado; West Roxbury, Massachusetts; Phoenix, Arizona; Little Rock, Arkansas; Tucson, Arizona; Hines, Illinois; Richmond, Virginia; Omaha, Nebraska, and Perry Point, Maryland. The well-defined cohort was followed to determine the long-term results of different GERD therapies. Patients were located with the help of a professional search agency. Patients were asked to: (1) record their GERD symptoms daily in a diary for 2 weeks (1 week on medications, 1 week off medications; (2) complete a health history questionnaire; (3) undergo endoscopy; and (4) have 24-hour esophageal pH monitoring. GRACI (symptom) scores were calculated using results from the symptom diaries. Seventy nine of the patients had died; 40% of the surgery patients died compared with only 28% of the medical patients (P .05). The difference in mortality was explained by a difference in cardiovascular deaths -- 48% in the surgical group vs 20% in the medical group. This observation remains unexplained. Of the 169 survivors from the original cohort, 161 were located. These patients provided follow-up for 10-13 years (see Table 1). Ta