Major new study aims to improve surgery options for acid reflux patients

A UK-wide research team, led by the University of Oxford's Nuffield Department of Surgical Sciences, has launched a major international study to improve surgical treatment for people suffering from gastro-oesophageal reflux disease (GORD), a chronic condition that affects around one in five adults in the UK.

The study - called the GOLF trial - is comparing two types of surgery to help patients and doctors choose the best approach for long-term relief, with fewer side effects. It is funded by the Efficacy and Mechanism Evaluation (EME) Programme, a partnership between the National Institute for Health and Care Research (NIHR) and the Medical Research Council (MRC).

GORD, commonly known as acid reflux, can cause severe heartburn, regurgitation, and discomfort, interfering with daily life. When medications like proton pump inhibitors (PPIs) don’t work - or lead to side effects - surgery may be recommended. Currently, the standard procedure is called fundoplication, which involves the surgeon wrapping the top part of the stomach around the lower end of the oesophagus. This action creates a bolster that tightens the valve between them, effectively preventing acid reflux. While it reduces reflux, it often causes problems like bloating and difficulty burping.

A newer alternative, known as the LINX procedure, uses a small ring of magnetic beads to support the valve between the stomach and oesophagus. Early results suggest LINX may lead to fewer side effects, but there has never been a large-scale comparison of the two surgeries - until now.

The GOLF study, led by Oxford University’s Nuffield Department of Surgical Sciences, involves 460 patients from the UK and Europe who suffer from ongoing GORD that hasn’t responded to medication. These patients will undergo either LINX or fundoplication surgery, with neither the patients nor the researchers who assess the outcomes knowing which treatment was received to ensure unbiased results. Over two years, the effectiveness of each surgical approach will be closely monitored.

Professor Sheraz R. Markar, Chief Investigator and Director of the Surgical Intervention Trials Unit at the University of Oxford, said: ‘This important international trial aims to improve the long-term health related quality of life for patients with gastro-oesophageal reflux disease through comparison of two established surgical treatments; fundoplication and the LINX procedure. We are hugely excited to undertake this trial and define the gold standard surgical treatment for gastro-oesophageal reflux disease.’

Mimi McCord, Chairman, Trustee and Director of Heartburn Cancer UK, added: ‘This study is the first large project of its kind to see whether the LINX procedure will give patients fewer side effects compared to fundoplication. We hope that patients who have the LINX procedure will benefit from feeling less bloating and enables them to burp freely which can be distressing for those effected, but we need the GOLF study to test if this is the case or not. The study will ensure that we have the evidence to show which procedure - LINX or fundoplication - is best in helping to control acid reflux in patients. For patients who do not want to have surgery, or it has not successfully controlled their symptoms, this is an exciting step forward. I am delighted to be part of this study. It is a major step forward in ensuring patients get the best surgical treatment for their acid reflux.’

More information about the trial can be found on the Nuffield Department of Surgical Sciences website.

The protocol for the GOLF trial has been published in the British Journal of Surgery.