This Week in JAMA FREE

Patients with gastroesophageal reflux disease (GERD) often require long-term medical treatment or antireflux surgery for symptom relief. To evaluate the long-term treatment efficacy of proton pump inhibitor therapy vs laparoscopic antireflux surgery, Galmiche and colleagues randomly assigned patients with chronic GERD who were initially responsive to proton pump inhibitor therapy to receive either esomeprazole (20-40 mg/d, allowing for dose adjustments) or standardized laparoscopic antireflux surgery. Patients were followed up for 5 years and the authors found that antireflux therapy—either by drug-induced acid suppression with esomeprazole or laparoscopic antireflux surgery—was associated with disease remission in most patients.

Between 1998 and 2008, the number of hospital-based emergency departments (EDs) in the United States declined, while the number of patient visits increased. In an analysis of data from the American Hospital Association Annual Surveys merged with financial information from the Centers for Medicare & Medicaid Services, Hsia and colleagues assessed hospital, community, and market factors associated with urban hospital-based emergency department closures. The authors found that hospital characteristics associated with a higher risk of emergency department closure between 1990 and 2009 included safety-net status, for-profit ownership, location in a competitive market, and having a low profit margin.

Maternal vitamin A deficiency is common in low-income countries. Some evidence suggests that prevention of vitamin A deficiency may improve maternal survival. In a cluster randomized placebo-controlled trial that enrolled pregnant women in rural Bangladesh, West and colleagues assessed the effect of a recommended dietary allowance of vitamin A or equivalent as beta-carotene (weekly, from the first trimester through 12 weeks postpartum) on maternal mortality, stillbirth, and infant mortality through 12 weeks of age. The authors report that compared with placebo, receipt of a weekly vitamin A or beta-carotene supplement was not associated with reductions in all-cause maternal, fetal, or infant mortality.

Older-generation antiepileptic drugs are associated with an approximately 3-fold increased risk of birth defects. However, little is known about the teratogenic effects of newer-generation antiepileptic drugs, which not only treat epilepsy but also increasingly are prescribed for bipolar mood disorders, migraine, and neuropathic pain syndromes. Mølgaard-Nielsen and Hviid examined the association between exposure to newer-generation antiepileptic drugs in the first trimester and the risk of major birth defects diagnosed within the first year of life in a population-based cohort study of 837 795 live-born infants in Denmark. The authors found that compared with no exposure, infants who were exposed to lamotrigine, oxcarbazepine, topiramate, gabapentin, or levetiracetam had no increased risk of major birth defects.

“Even after working four years, it's still hard for me to talk about this study with friends, with family.” From “Entering Data.”

New studies find that coronary artery bypass graft surgery is no more effective than medical therapy in preventing death in patients with heart failure, prompting questions about the invasive procedure's value in this patient population.

In-flight medical emergencies

From efficacy to effectiveness amid uncertainty

Limits of the Physician Payments Sunshine Act

Physician burnout and health care reform

Access and the Affordable Care Act

Join Eric Widera, MD, Wednesday, June 15, from 2 to 3 PM eastern time to discuss the handling finances for older patients with cognitive impairment. To register, go to http://www.ihi.org/AuthorintheRoom.

Ms S is a 41-year-old woman with breast cancer and a BRCA1 mutation. How would you reduce her future risk of breast cancer? Go to www.jama.com, to read the case. Submission deadline is May 29.

For your patients: Information about GERD.