This review critically appraises the evidence on the benefits and costs of the available treatments for gastroesophageal reflux disease (GERD) and concludes that antireflux surgery has no clear advantages over medical therapy for efficacy of healing, prevention of complications, safety, side effects, and cost. Indeed, medical therapy is safer and, probably, more cost-effective. Compared with medically treated patients, those who have successful fundoplication may be less inconvenienced by GERD because they are less likely to need to take pills on a daily basis. The patient and physician must judge whether that benefit justifies the risks of surgery for a benign condition. There is not yet sufficient data available on the endoscopic antireflux procedures to make meaningful conclusions regarding their safety and efficacy.
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