Condition

GERD

Gastroesophageal reflux disease - Chronic acid reflux

1.2B
People Affected
100
Active Trials
120M
New Cases/Year
1,500
Deaths/Year

Treatment Rankings

Ranked by evidence volume first. Medicine has spent centuries ranking things by vibes. This is an improvement.

1
Omeprazole (Proton Pump Inhibitor)
80% Effectiveness• 95% Confidence• 68% Safety• 52 trials• 200K participants
HIGH EvidenceExcellent ValueDose: 20-40 mg daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
68
DangerousModerateSafe

Time to Effect

1-2 hours for acid suppression, 1-2 weeks for full symptom relief

Duration

4-8 weeks for acute, often lifetime for maintenance

Response Rate

75%

Remission Rate

60%

Number Needed to Treat (NNT)

3

Number Needed to Harm (NNH)

500

Common Side Effects:

Headache: 7%
Diarrhea: 5%
Abdominal pain: 5%
Nausea: 4%
Constipation: 2%
Increased risk of C. difficile infection (long-term): 0.1%
Bone fractures (long-term): 0.5%

Annual Cost of Care

Drug Cost

$30

Monitoring

$150

Side Effects

$50

Total Annual

$230

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.08

ICER

$8,000/QALY

Cost per Remission

$383.33

Cost per Responder

$306.67

Treatment Outcomes
Primary Outcomes
Heartburn Severity Score2.5/3 (0=none, 3=severe)
-72% (-1.8 points)
Number of Weekly Acid Reflux Episodes6 episodes/week
-83.3% (-5.0 episodes/week)
Percentage Time Esophageal pH < 415%
-66.7% (-10 percentage points)
Secondary Benefits
GERD-Health Related Quality of Life (HRQoL) Score30/50 (higher is worse)
-43.3% (-13 points)
Frequency of Nocturnal Heartburn Episodes3 episodes/week
-83.3% (-2.5 episodes/week)
Number of Rescue Medication Doses/Week4 doses/week
-80% (-3.2 doses/week)
Common Side Effects
Headache
+7%
Diarrhea
+5%
Abdominal pain
+5%

Clinical Trial Phases:

Phase 3Phase 4
2
Nissen Fundoplication (Laparoscopic)
75% Effectiveness• 90% Confidence• 50% Safety• 44 trials• 20K participants
MODERATE EvidenceExcellent Value
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
50
DangerousModerateSafe

Time to Effect

Weeks for full post-operative recovery

Duration

One-time procedure, long-term follow-up

Response Rate

70%

Remission Rate

55%

Number Needed to Treat (NNT)

4

Number Needed to Harm (NNH)

10

Common Side Effects:

Dysphagia (transient): 20%
Gas-bloat syndrome: 15%
Diarrhea: 10%
Recurrence of GERD: 30%
Surgical complications (bleeding, infection): 3%

Annual Cost of Care

Drug Cost

$0

Monitoring

$200

Side Effects

$300

Total Annual

$2,000

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.25

ICER

$30,000/QALY

Cost per Remission

$3,636.36

Cost per Responder

$2,857.14

Treatment Outcomes
Primary Outcomes
GERD-HRQL Score28 (0-45 scale, higher indicates worse symptoms)
-65% (-18.2 points)
Esophageal Acid Exposure (% time pH < 4)12.0%
-75% (-9.0 percentage points)
Patients requiring daily PPIs100%
-85% (Reduction to 15% of patients)
Weekly Regurgitation Episodes5 episodes/week
-90% (-4.5 episodes/week)
Secondary Benefits
SF-36 Physical Component Summary (PCS) Score40 (normative mean is 50)
+20% (+8.0 points)
Chest Pain Severity Score (0-10 VAS)7.0/10
-71.4% (-5.0 points)
Sleep Disturbance Score (0-10 scale, higher indicates worse sleep)4.0/10
-75% (-3.0 points)
Common Side Effects
Dysphagia (transient)
+20%
Gas-bloat syndrome
+15%
Diarrhea
+10%

Clinical Trial Phases:

Phase 4
3
Transoral Incisionless Fundoplication (TIF)
68% Effectiveness• 80% Confidence• 60% Safety• 15 trials• 3K participants
MODERATE EvidenceGood Value
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
60
DangerousModerateSafe

Time to Effect

Weeks for full post-operative recovery

Duration

One-time procedure

Response Rate

65%

Remission Rate

50%

Number Needed to Treat (NNT)

4

Number Needed to Harm (NNH)

100

Common Side Effects:

Dysphagia (transient): 20%
Sore throat: 15%
Chest pain: 10%
Abdominal pain: 5%
Perforation: 0.1%

Annual Cost of Care

Drug Cost

$0

Monitoring

$150

Side Effects

$150

Total Annual

$2,300

Cost-Effectiveness

GOOD

QALYs Gained

0.15

ICER

$55,000/QALY

Cost per Remission

$4,600

Cost per Responder

$3,538.46

Treatment Outcomes
Primary Outcomes
GERD-Health Related Quality of Life (GERD-HRQL) Score28 (scale 0-50, higher is worse)
-71.4% (-20 points)
Average Daily PPI Dose Equivalent2 doses/day equivalent
-75% (-1.5 doses/day equivalent)
Esophageal Acid Exposure (% time pH<4)12%
-66.7% (-8 percentage points)
Heartburn Symptom Score3.5 (scale 0-5, higher is worse)
-85.7% (-3 points)
Secondary Benefits
Regurgitation Symptom Score3.0 (scale 0-5, higher is worse)
-83.3% (-2.5 points)
GERD-Related Sleep Disturbance Frequency4 nights/week
-75% (-3 nights/week)
Overall Treatment Satisfaction Score5 (scale 0-10, lower is worse)
+60% (+3 points)
Common Side Effects
Dysphagia (transient)
+20%
Sore throat
+15%
Chest pain
+10%

Clinical Trial Phases:

Phase 4
4
Famotidine (H2 Receptor Blocker)
60% Effectiveness• 90% Confidence• 82% Safety• 1 trials• 50K participants
HIGH EvidenceExcellent ValueDose: 20-40 mg once or twice daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
82
DangerousModerateSafe

Time to Effect

Within 1 hour

Duration

6-12 weeks for acute, often indefinite for maintenance

Response Rate

55%

Remission Rate

35%

Number Needed to Treat (NNT)

6

Common Side Effects:

Headache: 5%
Dizziness: 2%
Constipation: 2%
Diarrhea: 2%
Tachyphylaxis (reduced effectiveness over time): 15%

Annual Cost of Care

Drug Cost

$20

Monitoring

$150

Side Effects

$30

Total Annual

$200

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.05

ICER

$5,000/QALY

Cost per Remission

$571.43

Cost per Responder

$363.64

Treatment Outcomes
Primary Outcomes
Heartburn Symptom Severity3.5/5 on a GERD Symptom Scale
-57.1% (-2.0 points)
Frequency of Heartburn Episodes5 days/week
-70% (-3.5 days/week)
Frequency of Nocturnal Heartburn Episodes3 nights/week
-83.3% (-2.5 nights/week)
Esophageal Acid Exposure Time (pH < 4)10% of 24-hour period
-50% (-5 percentage points of 24h)
Secondary Benefits
Pittsburgh Sleep Quality Index (PSQI) Score10/21
-40% (-4 points)
GERD-Health Related Quality of Life (HRQOL) Score25/50
-40% (-10 points)
Use of Rescue Antacid Doses3 doses/day
-66.7% (-2 doses/day)
Common Side Effects
Headache
+5%
Dizziness
+2%
Constipation
+2%

Clinical Trial Phases:

Phase 4
5
Lifestyle Modifications
55% Effectiveness• 85% Confidence• 100% Safety• 5 trials• 30K participants
MODERATE EvidenceExcellent Value
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
100
DangerousModerateSafe

Time to Effect

Immediate for some, weeks to months for others (e.g., weight loss)

Duration

Lifetime

Response Rate

40%

Remission Rate

25%

Annual Cost of Care

Drug Cost

$0

Monitoring

$800

Side Effects

$0

Total Annual

$800

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.15

00
Treatment Outcomes
Primary Outcomes
Heartburn Frequency5 days/week
-50% (-2.5 days/week)
Heartburn Severity (0-10 scale)6.0/10
-41.7% (-2.5 points)
Regurgitation Frequency3 days/week
-40% (-1.2 days/week)
GERD-Health Related Quality of Life (GERD-HRQL) Score (0-50, lower is better)25/50
-36% (-9 points)
Secondary Benefits
GERD-related Sleep Disturbance (0-5 scale)3.0/5
-50% (-1.5 points)
Body Mass Index (BMI)30 kg/m^2
-5% (-1.5 kg/m^2)
Frequency of Antacid Use4 doses/week
-62.5% (-2.5 doses/week)